The Primary Care Payment Reform Collaborative—a legislatively mandated multi-partner advisory body charged with increasing investment in primary care and changing the way primary care is paid for— developed a recommended Primary Care VBP Model to be implemented by VBP Compact signatories. Learn more about the VBP Compact and the emphasis on primary care within VBP models in the Oregon VBP environment section.
The Primary Care VBP Model incentivizes Oregon’s Patient-Centered Primary Care Home (PCPCH) recognition. At a minimum, primary care practices must be familiar with the PCPCH certification requirements and the clinical model: PCPCH Recognition Criteria, Technical Specifications & Reporting Guide. See Section I Step 3 Assess your readiness for a new or modified VBP model(s) to learn more about Oregon’s PCPCHs.
For greatest success under the Primary Care VBP Model, practices are urged to become PCPCH-recognized as soon as possible, VBP Compact payers will incentivize and reward practices with PCPCH certification as part of their primary care VBP arrangements.
All practices can participate in the primary care VBP model. The primary care model does not require:
- minimum practice size thresholds (such as a certain number of assigned lives). See Section I Step 5 Understand member attribution and assignment. See Section I Step 7 Understand types of financial risk in VBP models to better understand VBP model implications for small practices
- performance pre-qualifications for practice, (such as minimum thresholds for performance on quality measures, should not be applied
The Primary Care VBP Model is envisioned as an all-payer primary care payment model which aligns with CMS primary care models, includes behavioral health integration and the following payment model components:
- Prospective payments (capitated or lump sum) for a defined set of primary care services
- Risk-adjusted infrastructure payments
- Fee-for-service payments for services not covered by the prospective payments
- Performance-based incentive payments
VBP Toolkit Menu
- Understand VBP models
- Educate your team on VBP terms and models
- Assess internal interest and understanding of VBP
- Assess your readiness for a new or modified VBP model(s)
- Identify current data analytical capabilities and gaps
- Understand member attribution and assignment
- Understand your population and health disparities
- Understand types of financial risk in VBP models
- Get ready for VBP
- Go live with VBP model(s)
- Promote provider clinical transformation to foster VBP success
- Access technical assistance and peer learning
- Understand how quality is measured and used in different VBP models
- Maximize quality improvement – performance on measures
- Review results and make modifications
- Scale up current VBP contracts and engage additional payers
- Understand VBP compact models
- Primary care model
- Specialty care models (future content)
- Hospital care model (future content)
When defining services included in capitated payments, the Primary Care VBP Model focuses on primary care services provided, not on specific provider types. This approach allows for inclusion of primary care services provided by a diverse array of care team members.
In general, capitated services in this primary care model will include services that:
- Are widely performed by primary care practices
- Represent a preponderance of primary care spending
Similarly, primary care model capitation payments will typically exclude services:
- Performed at widely varying rates among practices and/or offered inconsistently, such as behavioral health services
- Subject to potential underutilization and where there is interest in incentivizing increased volume
- Largely outside the control of primary care practices, such as certain expensive specialist procedures and inpatient stays
While behavioral health services are typically excluded from primary care model capitation payments, payers may offer primary care practices a behavioral health infrastructure payment to support integrated behavioral health services not typically paid for under fee-for-service mechanisms.
Specific Primary Care Services Included in the Prospective Payment
Prospective Capitation Rate Development Methodology
Primary Care VBP Model Infrastructure Payments