Bolstering Small-Practice “Medical Home” Capabilities
Small independent primary care providers are a vital lifeline for New Yorkers, providing services to many diverse and often disadvantaged communities. While they make up approximately 40 percent of all primary care providers in New York City and State, these practices are at risk of falling behind in the race toward medical home recognition and value-based purchasing.
Understanding that challenge, UHF brought together more than 30 experts last year to discuss the potential for shared services among small practices—a way to pool resources for practice transformation and eventual value-based purchasing (VBP). The results of that convening and subsequent efforts are now being finalized, with an anticipated release this spring.
Part of UHF’s partnership with the New York City Department of Health and Mental Hygiene and the New York City Population Health Improvement Program, the roundtable discussion solicited expert feedback on a white paper entitled New York City Population Health Improvement Program (PHIP) Small Primary Care Practice Project, Draft Interim Report, which was provided to participants in advance for their review and comment. That report reviewed:
- Findings from a series of focus groups of small-practice providers in New York City, describing a specific set of capacities the practices felt they needed to operate as medical homes and participate in VBP contracts, but could not afford on their own. Providers reported willingness to consider sharing services with other small practices if those services were affordable and provided by a trusted organization with a track record of competence;
- Findings from a series of interviews with organizations in New York State that are providing a range of services to small practices, describing the types of services offered and how they are organized, deployed, and supported.
The conversation reinforced the findings of this qualitative research, particularly related to the core competencies of medical homes and preparation for value based payment.
Of particular value were discussions on the scope of the shared service “bundle” that was envisioned, with discussants recommending that it include support in two priority areas with which many small practices often struggle:
- The adoption and best use of electronic medical records, and
- Practice management consultation and support on operational issues and on compliance with complex and changing requirements related to billing and coding.
The Draft Interim Report and roundtable findings served as the foundation for subsequent quantitative work describing the legal and regulatory issues involved in establishing a shared service program, and modeling the economics of such a venture. The final report will bring together both the qualitative and quantitative reports findings of the project.