Prospective Payment for Primary Care: Lessons for Future Models

Abstract

Realizing a vision for advanced primary care in the United States will require adopting new payment strategies. The predominant payment scheme under which primary care practices operate—and their primary source of revenue—is fee-for-service payment. However, fee-for-service is not structured to support or sustain a comprehensive primary care system. Prospective payment for primary care is an alternative payment model that can facilitate care delivery transformations to better manage population health. It offers practices a predictable source of revenue, and the flexibility to manage care within a budget to optimize outcomes for a population of patients. Earlier primary care prospective payment models, such as those commonly employed in the 1990s, offer lessons and insights for designing a prospective payment for primary care that will facilitate the delivery of comprehensive, coordinated, and patient-centered primary care.

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