Payment Innovations and Spread: An Innovations Bazaar

Angel Kids Pediatrics is unlike any other pediatric primary practice in Jacksonville. Considered an extraordinary resource to the community, by the community in providing more than just basic health care services to the poor and other special populations, Angel Kids leads the charge in serving groups that have gone unseen, through the delivery of integrated, high quality physical and behavioral health care services. As a practice within the private sector that supports a large proportion of underinsured patients, the commitment and mission of providing excellent medical care in a community based environment and bringing access to mainstream health care services to at risk communities plays a vital role of making a positive difference in health outcomes. Founded in 2003, Angel Kids Pediatrics is now the largest private pediatric health practice in Northeast Florida with nine convenient locations throughout Jacksonville. Angel Kids Pediatrics’ team of more than 30 providers and 100 employees work together to deliver high-quality care for nearly 30,000 patients, ranging from newborn to age 18. Angel Kids Pediatrics provides excellent medical care in a family- and community-based environment while upholding the highest standards of a patient-centered medical home that provides quality, personalized, accessible and effective medical and behavioral health care. The mission of Angel Kids Pediatrics extends beyond the walls of the clinics in preserving the welfare of children in the community, supporting preventative services and routine access to trusted health care providers. Together with his skillful team, Founder, Dr. Ashraf Affan has built an award winning, diverse practice recognizing that it is imperative to remain agile in approaches, and continually put emphasis on the profound ability to build and sustain lasting relationships with patients and community collaborators.

Blue Shield of CA implemented a hybrid payment model designed to increase the share of health care dollars directed toward primary care practices, providing consistent revenue that facilitates flexibility and relationship-based care. We also developed a novel risk adjustment methodology that more accurately reflects cost and utilization associated with primary care services. To scale the model, we built a team called Industry Initiatives that is devoted to driving multi-payer alignment by helping other payers adopt similar value-based payment models. Industry Initiatives funded third-party conveners to bring the state’s largest health plans together to drive that multi-payer alignment, and successfully achieved commitments from the plans to align on investment, payment, measurement, and practice transformation support for primary care.

The Maryland Primary Care Program’s (MDPCP) pioneering Health Equity Advancement Resource and Transformation (HEART) payment is one of the Center for Medicare and Medicaid Innovation’s (CMMI) first payment mechanisms to account for social risk. This payment model provides a new separate payment to practices serving patients with greater social needs. In January 2022, MDPCP rolled out the HEART payment to nearly 500 participating primary care practices. The payment provides practices with an additional $110 per beneficiary per month for every attributed Medicare beneficiary with significant clinical risk (based on Hierarchical Condition Categories or HCC score) and socio-demographic risk (based on Area Deprivation Index or ADI score). The HEART payment aims to address the complex needs of under-resourced Medicare beneficiaries, meeting social needs in the short term, and improving clinical outcomes over time.

VillageMD is committed to offering high-quality, accessible primary care options for communities across the country through Village Medical. VillageMD partners with physicians to provide the tools, technology, operations, staffing support and industry relationships to deliver high-quality clinical care and better patient outcomes, while reducing the total cost of care. The Village Medical brand provides value-based primary care for patients at traditional free-standing practices, Village Medical at Walgreens practices, at home and via virtual visits. VillageMD and Village Medical have grown to 22 markets and are responsible for more than 1.6 million patients. To learn more, please visit www.villageMD.com

The AAFP has put forth a set of guiding principles which outline best practices for primary care payment that are most conducive to supporting high-value primary care. The AAFP is preparing to support implementation of the principles in practice through a multi-modal approach including expanding on the principles through a series of position papers, identifying and elevating bright spots in VBP, creating tools to evaluate and compare approaches to value-based payment based on their alignment with these principles, equipping AAFP state chapters to be effective change agents at the local level, and using the principles to guide the AAFP’s advocacy efforts with public and private stakeholders. We aim to gain feedback on our planned approach and other stakeholders we should be engaging in this work.