Delivery System Transformation

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Photo courtesy of PrairieStar Health Center

The challenge of improving population health while keeping costs down requires systematic change to how health care is paid for and delivered to patients. Though the delivery system has been failing vulnerable populations who need it most, national health expenditures recently reached $3.6 trillion, accounting for 17.7% of the GDP.

PCDC believes that the solution is predicated on a system-wide focus on primary care — the critical, cost-effective care and services that help prevent and treat diseases before they become serious and costly. PCDC’s financing and technical assistance work across the country has enabled providers to pursue the transformation the system needs. Primary care needs supportive policies and sufficient funding to deliver its full potential: better health outcomes, saved lives, and lower costs.


Our Policy Priorities

RE-FOCUSING DELIVERY SYSTEM TRANSFORMATION ON PRIMARY CARE

Primary care must be a central priority in delivery and payment system transformation efforts.

PCDC supports efforts made in several states to transform the health care system, including using 1115 Medicaid Waivers to implement initiatives such as DSRIP. There are also promising state and federal strategies to advance health care payment and delivery system reform models — ultimately strengthening community health, improving clinical outcomes, and reducing costs.

However, the desired transformation can only be accomplished with sufficient, quality primary care that is accessible to all families and communities. The need for increased investment and more effective policies to achieve the promise of primary care is clear. PCDC has worked across the country and advocated at the state and federal levels to enhance primary care within system transformation.

INVESTING IN PATIENT-CENTERED MEDICAL HOMES (PCMH)

Protect funding for Patient-Centered Medical Homes (PCMH) incentive programs.

The PCMH model relies on primary care physicians to coordinate care for their patients in an appropriate manner where and when they need it. PCMH puts patients at the forefront of their care delivery. Research shows that PCMHs build better relationships between patients and their care teams; improve quality, patient experience, and staff satisfaction; and reduce health care costs.

Since 2008, PCDC’s content experts have helped more than 760 practices achieve PCMH recognition. PCMH has been central to health care payment reform in Medicaid, Medicare, and commercial health plans. Many states have also linked PCMH to financial incentives for providers.

Given the demonstrated benefits the PCMH program has and will continue to produce, PCDC has persistently advocated for renewed and increased funding for these programs and supported policies that will expand the model’s reach and impact.

PROTECTING THE 340B DRUG DISCOUNT PROGRAM

Preserve the 340B Drug Pricing Program and protect medically underserved communities.

The 340B Program entitles qualifying covered entities — Health Resources and Services Administration (HRSA)-supported health centers, AIDS drug assistance programs, and safety net hospitals and providers — to receive discounts on eligible outpatient drugs. Covered entities may provide 340B drugs to all eligible patients, regardless of a patient’s payer status and how the drug is administered.

Through working in rural and urban communities across the country, PCDC intimately understands how safety net providers rely on the 340B Program to bring accessible care to underserved patients. In recent years, the program has faced several threats both nationally and at the state level, which PCDC has vehemently opposed and advocated against. Because 340B providers exclusively see the most vulnerable populations, limiting the program will disproportionally impact these already hard-hit communities. PCDC strongly supports policies that safeguard the program and its vital benefits.

Spotlight

To date, PCDC has assisted more than 760 care practices to achievePatient-Centered Medical Home (PCMH)recognition with a 100 percent success rate. PCDC supports primary care practices across the nation — community health centers, hospital clinics, private practices, and specialty practices. We meet practices where they are to create individualized plans for achieving PCMH recognition, including one-to-one coaching, tools, resources, and support.