Primary Care VBP Model Infrastructure Payments

Primary Care VBP Model Infrastructure Payments

Infrastructure payments to all practices participating in the Primary Care VBP Model should include the following components:

  1. A base payment tied to PCPCH Program tier, as well as payments to non-PCPCH practices that are actively seeking to obtain PCPCH recognition.
  2. Additional payments, as agreed upon by the payer and practice, for specific high-value services. These additional infrastructure payments should be for services that are included in the PCPCH Standards where the practice has identified a need for additional financial support for implementation or sustainability.

For services that fall under the second category of infrastructure payments which are also included in the PCPCH Recognition Standards, validation of the level of service for PCPCH-recognized practices should be tied to the corresponding PCPCH standard and measure, rather than via a separate or additional validation process.

Examples of services not paid for via the prospective payment include, but are not limited to, the following:

  • Additional care management and care coordination supports for patients with higher levels of medical and social risk.
  • Traditional health worker services, including services from peer support specialists, peer wellness specialists, personal health navigators, community health workers, and doulas.
  • Integrated pharmacist services, such as medication consultations.
  • Addressing health-related social needs (HRSN), such as through HRSN screenings and supporting collaboration and data-sharing between primary care practices and social services organizations.
  • Infrastructure (technology and staff) to collect and use REALD and SOGI data.
  • Integrated behavioral health services not typically paid for under fee-for-service mechanisms.

Innovative equity-focused services in response to an identified practice or community-specific need (such as funding for bus fares for patients with transportation needs).