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www.macpr.org


Welcome to MACPR!

Massachusetts Coalition for Primary Care Reform
 
 
 Mission Statement:
 
To develop, pilot, and evaluate fundamental reform of practice and payment for primary care

Background: Primary care serves as the foundation of every health care delivery system, as denoted by its definition: the provision of first-contact, coordinated care that is comprehensive, continuous, and personalized. Where people have access to primary care, health care costs are lower, health care outcomes are better, and health care disparities are fewer.  Despite these essential contributions, primary care in the U.S. has been in a state of rapid deterioration, with practices closing, new medical graduates shunning the field, and access to primary care increasingly problematic. The current crisis in U.S. health care parallels the decline in primary care, which can be traced to a dysfunctional payment system and outdated modes of practice. There is broad consensus that revitalizing primary care is essential to fixing our nation’s health care system.

Founding of MACPR: The Massachusetts Coalition for Primary Care Reform (MACPR) was founded in 2008 by a group of primary care reformers intent on developing, piloting, and evaluating new modes of primary care payment and practice.  Joining with them in the developmental effort have been experts in such areas as practice redesign, quality assessment, health information technology, and actuarial science, as well as primary care practices willing to serve as piloting sites.  Supporting the piloting effort are provider networks, medical service companies, and payers committed to field testing fundmanetal reform.  Start-up funding for the Coalition has been provided by private donors along with substantial in-kind contributions from Coalition members.  Foundation support has been pledged for the evaluation effort. 

Project Strategy and Plan:  The seriousness of the current crisis in primary care begs a more ambitious approach than simply fine-tuning the current sytem.  MACPR collaborators have chosen to develop, field test, and evaluate fundamental reforms of primary care payment and practice.  The strategy entails implementing a new practice model – the patient-centered medical home (PCMH) – in conjunction with a new payment model – risk-adjusted comprehensive payment (see below).  We believe that revitalization of primary care requires fundamental reform, because the current systems of payment and practice are fundamentally flawed and discouraging of high-performance primary care .   

The MACPR piloting effort consists of field-testing these payment and practice reforms for two years in high-performing small to medium-sized primary care practices. Selection criteria for participating practices include 1) operation of an interoperable electronic medical record, 2) commitments to team-based practice and sharing of outcomes data, 3) patient-centeredness, 4) willingness to implement and pilot the MACPR payment reform model for a minimum of 2 years, and 5) achieving NCQA Medical Home accreditation. Ten leading primary care practices, 7 in the greater Boston area and 3 in the Albany, NY, area signed on; 5 have received the necessary funding and launched their all-patient piloting. 

Unlike other primary care practice reform efforts, the MACPR initiative involves all patients in a practice.  This approach is based on our view that enhanced primary care should be the standard for all patients and not limited to a particular subset.  Having the reform effort applied practice-wide also facilitates practice transformation and minimizes the distortions and difficulties associated with “carve-out” initiatives.  

Being a field test of reform, the MACPR initiative includes a detailed evaluation of its impact on practice performance and outcomes.  The key outcome parameters to be examined include measures of cost, quality, patient experience, and professional satisfaction.  Validated measures will be used, and participation in a foundation-sponsored national evaluation effort of medical home piloting is planned.      

Project Status: The Coalition held it founding retreat in November of 2008.  Since then, 10 primary care practices have signed on to serve as piloting sites. Funding has been secured for five, which launched their piloting efforts between Jan 2009 and Jan 2010.  The others continue working on preparatory  practice transformation as they await funding to support their piloting.  Current field testing involves about 50 physicians and 75,000 patients. Developmental work continues on evaluation protocols and the bonus payment mechanism, particularly on its risk-adjustment. 

Early Results and Future Plans:
Very preliminary results from the first practices to launch piloting suggest positive outcomes in a number of important areas.  Physician morale is reportedly very high with the changes in practice and payment. The most promising improvements in outcome measures appear to be emanating from those practices that have made the most progress in medical home transformation. As piloting progresses, much more data will emerge. We look forward to fast-track expansion of the piloting effort over the coming year and much more data from those practices that have already begun field testing fundamental reforms of payment and practice of primary care.    

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