(Note: This article originally appeared in Health Affairs Blog on July 21, 2014. An edited version is being reposted here as part of the research effort investigating the impact of Alternative Payment Methodology (APM) on the delivery of primary care in safety-net populations. Through this website, Frontiers of Health Care, we are sharing lessons learned and perspectives from key stakeholders on the frontlines of reform.)
The Alternative Payment Methodology (APM) demonstration project enables participating Oregon community health centers to receive a monthly payment based on the size and composition of their patient population. This payment replaces the model of earning revenue based on the number of individual patients seen, shifting the paradigm from the number of doctor visits to the provision of high-quality, team-based, patient-centered care.
So what are the real changes physicians are seeing on the ground in clinics where APM is being implemented?
According to Dr. Chris Hill, a physician and co-director of the Virginia Garcia (VG) Hillsboro Clinic and Medical Center, primary care was once so focused around payment it was like a “hamster wheel” of patient visit after patient visit. Under the new Alternative Payment Methodology (APM) pilot in community health centers throughout Oregon, care teams are freed up to do other things, such as managing panels of patients and designing programs to promote healthy behaviors and prevent illness. Dr. John Guerreiro, also a physician at VG, is enthusiastic; he sees APM as a pathway to realizing the full promise of team-based care.
Team-Based Care, Longer Visits, And New Ways To Reach Patients
The changes at VG, a federally qualified health center with multiple locations in Oregon, started about five years ago with a shift to the patient-centered primary care medical home.
“That’s when we first put a group of staff into a care team,” explains Hill. Care teams are typically comprised of a physician lead, physician assistants or nurse practitioners, nurses, and medical assistants. At VG, these teams are the hub of patient care. “What’s changed with APM is that we’ve really put the focus on the care teams to be the place where we start managing the panel.” Continue reading