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January 2018

Payment Reform to Enhance Collaboration of Primary Care and Cardiology: A Review

Author Affiliations
  • 1Center for Healthcare Innovation and Policy Research, George Washington University School of Medicine and Health Sciences, Washington, DC
  • 2Duke–Robert J. Margolis Center for Health Policy, Duke University, Durham, North Carolina
  • 3American College of Cardiology, Washington, DC
  • 4Accountable Care Organization of New York Presbyterian, Columbia, and Weill Cornell Medicine, New York
  • 5Atlantic Health System, Morristown, New Jersey
  • 6American College of Physicians, Philadelphia, Pennsylvania
  • 7American College of Osteopathic Family Physicians, Arlington Heights, Illinois
  • 8American Academy of Family Physicians, Leawood, Kansas
JAMA Cardiol. 2018;3(1):77-83. doi:10.1001/jamacardio.2017.4308

Importance  The US health care system faces an unsustainable trajectory of high costs and inconsistent outcomes. The fee-for-service payment model has contributed to inefficiency, and new payment methods are a promising approach to improving value. Health reforms are needed to increase patient access, reduce costs, and improve health care quality, and the landmark Medicare Access and CHIP Reauthorization Act presents a roadmap for reform. The product of a collaboration between primary care and cardiology clinicians, this review describes a conceptual approach to delivery and payment reforms that aim to better support primary care–cardiology comanagement of chronic cardiovascular disease (CVD).

Observations  Few existing alternative payment models specifically address long-term management of CVD. Primary care medical homes and accountable care organizations come closest, but both emphasize primary care, and cardiologists have often not been well engaged. A collaborative care framework should articulate distinct roles and responsibilities for primary care and cardiology in CVD comanagement. Finally, a series of payment models aim to better support clinicians in providing accountable, seamless, and patient-centered cardiac care.

Conclusions & Relevance  Clinical leadership is essential during this time of change in the health care system. Patients often struggle to navigate a fragmented and expensive system, whereas clinicians often practice with incomplete information about tests, treatments, and recommendations by their colleagues. The payment models described in this review offer an opportunity to create more satisfying approaches to patient care while improving value. These models have potential to support more effective coordination and to facilitate broader health care system transformation.

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