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September 12, 2019

Primary Care Selection: A Building Block for Value-Based Health Care

Author Affiliations
  • 1Blue Cross Blue Shield of North Carolina, Durham
JAMA. 2019;322(16):1551-1552. doi:10.1001/jama.2019.14190

Over the past 10 years, the US health care system has undergone a significant shift in the structure of health care delivery. Many hospitals and physician groups have organized themselves to address the most pressing national priorities in health care: controlling increases in the cost of care and improving the quality of care that US residents receive. Payers, both public and private, have supported this shift by implementing new alternative models of payment that incent the delivery of cost-efficient, high-quality care. The most promising alternative payment model to fee-for-service payment is the accountable care organization (ACO) model. Some available evidence suggests that ACOs, both for Medicare beneficiaries and for commercially insured patients, reduce total cost of care and improve quality.1-3 Although there are different ways to construct ACO models, at its core, an ACO is a contract between clinicians and the payer to meet rigorous clinical quality and experience goals and lower spending.

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    1 Comment for this article
    There May Be Choice But There's No True Selection
    Eric Reines, MD | Element Care PACE
    “Primary Care Selection” is often a fiction. As a patient I may “select” the physician with the outstanding local reputation, only to find out their “panel is closed.” Then I may look for a physician who would refer to the specialist that I have seen for years. And when I finally get an appointment with my “selected” PCP, I would discover that I am seeing a mid-level clinician.