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Lessons for policymakers APMs are falsely promoted as a panacea for health system problems. They should instead be seen as kindling for ongoing primary care innovation within a continuous learning health system. Regardless of the APM chosen, overall spending on primary care must increase to achieve health system aims. Lessons for payors The small-scale and unsustainable design of many APM pilot programs creates payor “pilotitis.” Both countries must foster “learning at scale,” as demonstrated in the US CPCI. Canada needs an innovation center like the US' CMMI to foster and evaluate scaled payment experiments across a provincial delivery models. Lessons for researchers We need more robust evaluation released more rapidly, with stronger comparison groups, and increased transparency of results. We need evaluations of how APMs promote or inhibit health equity. For example, how can we adjust for variation in SDoH without excusing poor quality? Lessons for providers APMs that promote flexibility and pursuit of end outcomes over process measures increase both patient satisfaction & primary care provider wellness. Practices cannot bear all transformation risk, and require prospective, preferably population-based payment, i.e. capitated or blended payment. CMMI, Center for Medicare and Medicaid Innovations; CPCI, Comprehensive Primary Care Initiative SDoH, Social Determinants of Health.
First Name Last Name Job Title Institutional Affiliation: Country State or Province Richard Allman Chief Consultanta, Geriatrics and Extended Care Department of Veterans Affairs United States District of Columbia Sharon Arnold Acting Director, AHRQ AHRQ United States Maryland Kris Aubrey-Bassler Director, Primary Healthcare Research Unit Memorial University Canada Newfoundland and Labrador Bruce Bagley Senior Advisor to AMA AMA United States Illinois Elizabeth Bayliss Director Kaiser Permanente Institute for Health Research United States Colorado Andrew Bazemore Director Robert Graham Center for Policy Studies, AAFP United States District of Columbia Marie-Dominique Beaulieu Professor, Family Medicine Department, Univ. Montréal, Scientific Director of the Quebec SPOR SUPPORT Unit Université de Montréal Canada Quebec Robert Berenson Institute Fellow the Urban Institute United States Onil Bhattacharyya Frigon-Blau Chair in Family Medicine Research Women's College Hospital Canada Ontario Arlene Bierman Director, Center for Evidence and Practice Improvement AHRQ United States Maryland Andy Bindman Professor University of California San Francisco United States California Richard Birtwhistle Director Centre for Studies in Primary Care Department of Family Medicine Queen's University Canada Ontario Caroline Blaum Diane and Arthur Belfer Professor of Geriatrics; Director, Division of Geriatric Medicine and Palliative Care NYU School of Medicine United States New York Luc Boileau President and Chief Executive Officer Institute for Clinical Excellence in Health and Social Services (Québec-Canada) Canada Quebec Fred Burge Professor, Family Medicine Dalhousie University Canada Nova Scotia June Carroll Clinician Scientist University of Toronto Canada Ontario Michelle Carroll RN Nursing Supervisor All Nations Healing Hospital, Fort Qu'Appelle, Sk. Canada Saskatchewan Christine Chang Associate Director, AHRQ EPC Program Agency for Healthcare Research and Quality United States Maryland Susan Chatwood Executive and Scientific Director Institute for Circumpolar Health Research Canada Northwest Territories Candice Chen Director, Division of Medicine & Dentistry HRSA United States Maryland Marshall Chin Professor of Healthcare Ethics in the Department of Medicine University of Chicago United States Illinois Patrick Conway Acting Administrator, Centers for Medicare and Medicaid Services Centers for Medicare and Medicaid Services United States Maryland Dayna Cooper Director, Home and Community Care Department of Veteran Affairs United States District of Columbia Debbie DeLancey Deputy Minister Health and social services Canada Northwest Territories Jen DeVoe Professor and Chair Oregon Health & Science University United States Oregon Patrick Dicerni Assistant Deputy Minister Ministry of Health and Long-Term Care Canada Ontario Perry Dickinson Professor University of Colorado, Department of Family Medicine United States Colorado Kristen Dillon Director, Gorge Coordinated Care Organization PacificSource Health Plans United States Oregon Brent Diverty Vice-President, Programs CIHI Canada Ontario Erica Dobson Associate, Major Initiatives Canadian Institutes of Health Research Canada Ontario Shelley Doucet Professor and Research Chair in Interprofessional Patient-Centred Care UNB Saint John Canada Elizabeth Drake Advisor, Knowledge Translation Canadian Institutes of Health Research Canada Ontario Karen Earnshaw Vice Presiden–Integrated Health Service None Canada Saskatchewan Susan Edgman-Levitan Executive Director Massachusetts General Hospital Stoeckle Center for Primary Care Innovation United States Massachusetts Carolyn (Lynn) Edwards Senior Director Provincial Primary Health Care Canada Nova Scotia Bernard Ewigman Chairman University of Chicago United States Sarah Fielden Senior manager, evaluation Doctors of BC Canada British Columbia Jonathan Foley Member and Co-Founder, Westcott Partners, LLC Westcott Partners, LLC United States Maryland Diane Forbes Director, Strategic Operations CIHR-ICRH Canadian Institutes of Health Research Canada Alberta Martin Fortin Professor / Family Physician Université de Sherbrooke Canada Quebec Barbara Foster A/Manager–Crossing Cutting Division, Health Canada government Canada Ontario José Francois Head, Department of Family Medicine University of Manitoba Canada Manitoba Ted Ganiats Senior Staff Fellow AHRQ United States Maryland Frank Gavin Board Member Ontario SPOR Support Unit Canada Ontario Lauren Gerlach Senior Manager AcademyHealth United States District of Columbia Rick Glazier Senior Scientist Institute for Clinical Evaluative Sciences Canada Ontario Michael Gluck Senior Director Academyhealth United States District of Columbia Stephanie Gold Scholar Eugene S. Farley, Jr. Health Policy Center United States Colorado Michael Green Associate Professor Queen's University Canada Ontario Antoine Groulx Deputy General Director, Health Services And University Affairs Ministry of health and social services Canada Quebec Eva Grunfeld Vice Chair (Research) and Physician Scientist University of Toronto Canada Ontario Jeannie Haggerty Professor McGill University Canada Quebec Sara Harbord Project Lead Canadian Institutes of Health Research Canada Ontario Anne Hayes Director, Research, Analysis and Evaluation Branch Ministry of Health and Long-term Care Canada Ontario Brenda Hefford Executive Director, Community Practice Quality and Integration Doctors of BC Canada William Hogg Family Physician Department of Family Medicine, University of Ottawa Canada Ontario Rhonda Hogg Executive Director, Finance Manitoba Health, Seniors and Active Living Canada Manitoba Lauren Hughes Deputy Secretary for Health Innovation Pennsylvania Department of Health United States Pennsylvania Zeena Johar Research Fellow Duke Margolis Center for Health Policy United States District of Columbia Sharon Johnston Family Physician University of Ottawa Canada Ontario Janusz Kaczorowski Professor and Research Director Université de Montréal and CRCHUM Canada Quebec Alan Katz Professor Community Health Sciences and Family Medicine Manitoba centre for Health policy Canada Manitoba David Keahey Chief Policy and Research Officer Physician Assistant Education Association United States Virginia Ali Khan Regional Medical Officer, Northern California/Bay Area CareMore United States California Meredith Kratzmann Senior Project Officer CIHR–Institute of Health Services and Policy Research Canada Ontario Anton Kuzel Chair, VCU Department of Family Medicine and Population Health Virginia Commonwealth University United States Virginia Maryjoan Ladden Senior Program Officer RWJF United States New Jersey France Légaré Professor Université Laval Canada Quebec Francine Lemire CEO and Executive Director The College of Family Physicians of Canada Canada Ontario Evelyn Lewis&Clark Chief Medical Officer Warrior Centric Health, LLC AAFP United States Georgia Winston Liaw Medical Director Graham Center United States Virginia Clare Liddy Associate Professor, Family Medicine Bruyere Research Institute, University Ottawa Canada Ontario Anne Lyddiatt Consumer/Patient CIHR SPOR Canada Ontario Gregory Marchildon Professor University of Toronto Canada Nancy Mason MacLellan Manager, Major Initiatives Canadian Institutes of Health Research Canada Ontario Michael McGinnis Leonard D. Schaeffer Executive Officer National Academy of Medicine United States District of Columbia Bob McNellis Senior Advisor for Primary Care AHRQ United States Maryland Patricia (Patty) Menard Chief Department of Family Practice Canada Nova Scotia David Meyers Chief Medical Officer AHRQ United States Maryland Therese Miller Deputy Director, Center for Evidence and Practice Improvement AHRQ United States Maryland Justin Mills Medical Officer AHRQ United States District of Columbia William Montelpare Professor, Margaret & Wallace McCain Chair in Human Development and Health University of PEI Canada Prince Edward Island Nazeem Muhajarine Professor U of Saskatchewan Canada Saskatchewan Tim Murphy VP Platforms and SPOR Health Canada Alberta Heather Mustoe Associate Canadian Institutes of Health Research Canada Ontario Jessica Nadigel Assistant Director CIHR-Institute of Health Services and Policy Research Canada Quebec Cordell Neudorf Chief Medical Health Officer Saskatoon Health Region Canada Saskatchewan Tom Noseworthy Professor Cumming School of Medicine, University of Calgary Canada Alberta Maeve O'Beirne Director Patient's Medical Home Department of Family Medicine, University of Calgary Canada Alberta Jose Pereira Director, Research The College of Family Physicians of Canada Canada Ontario Nav Persaud Assistant Professor & Staff Physician University of Toronto & St Michael's Hospital Canada Ontario Hoangmai Pham Senior Fellow Duke Robert Margolis Center for Health Policy United States District of Columbia Jenny Ploeg Professor, School of Nursing McMaster University Canada Ontario Maria Portela Branch Chief Medical Training and Geriatrics HHS United States District of Columbia David Price Professor and Chair, Department of Family Medicine McMaster University Canada Kalpana Ramiah Director of Research America's Essential Hospitals United States District of Columbia Vivian Ramsden Professor and Director, Research Division Department of Family Medicine, University of Saskatchewan Canada Saskatchewan Robert Reid Chief Scientist, Institute for Better Health and Senior Vice President, Science, Trillium Health Partners Trillium Health Partners–Institute for Better Health Canada Richard Ricciardi Director, Division of Practice Improvement - AHRQ AHRQ United States Maryland Eugene Rich Director, Center on Health Care Effectiveness Mathematica Policy Research United States Maryland Nancy Roberts Executive Director–Primary Health Care New Brunswick Department of Health Canada New Brunswick Brian Rowe Scientific Director, ICRH; Professor, University of Alberta University of Alberta Canada Alberta Denis Roy VP, Science and Clinical Governance, INESSS, QC INESSS (Institut National D'excellence en Santé et Services Sociaux) Canada Quebec Lisa Rubenstein Professor of Medicine and Public Health, VA Greater Los Angeles and UCLA US Department of Veterans Affairs United States California Robert Saunders Research Director Duke-Margolis Center for Health Policy United States District of Columbia Michael Schull President and CEO Institute for Clinical Evaluative Sciences Canada Ontario Annette Schultz Associate Professor, Research Lead Manitoba PICHI Network College of Nursing, Rady Faculty of Health Sciences, University of Manitoba Canada Manitoba Laura Sessums Director, Division of Advanced Primary Care Center for Medicare and Medicaid Innovation United States District of Columbia Alyssa Shell Resident Physician American Board of Family Medicine United States North Carolina Scott Shipman Director of Primary Care and Workforce Analysis Association of American Medical Colleges United States District of Columbia Judith Steinberg Chief Medical Officer, Bureau of Primary Health Care Health Resources and Services Administration United States Maryland Moira Stewart Distinguished University Professor Department of Family Medicine, Western University Canada Ontario Robyn Tamblyn Scientific Director CIHR-Institute of Health Services and Policy Research Canada Ontario Joshua Tepper President & CEO Health Quality Ontario Canada Ontario Marcia Thomson Assistant Deputy Minister Manitoba Health Canada Manitoba Andrea Thoumi Managing Associate Duke University–Margolis Center for Health Policy United States District of Columbia Barbara Tobias Vice Chair UC Dept Family and Community Medicine United States Ohio Michael Tuggy Vice Chair, FMAH Health FMA Health United States Washington Jeffrey Turnbull Chief Clinical Quality/Chief of Staff Health Quality Ontario/The Ottawa Hospital Canada Ontario Doug Tynan Director of Integrated Health Care American Psychological Association United States Delaware Uche S. Uchendu Chief Officer, US Dept. of Veterans Affairs, Office of Health Equity United States Department of Veterans Affairs United States District of Columbia Ross Upshur Professor University of Toronto Canada Ontario Stephen Vail Director, Policy Canadian Medical Association Canada Ontario Kate Vickery Clinician-Investigator Hennepin County Medical Center United States Minnesota Eric Weil Chief Medical Officer, Primary Care, Partners Healthcare Center for Population Health, Partners Healthcare United States Massachusetts David White President The College of Family Physicians of Canada Canada Ontario Shanita Williams Deputy Director Health Resources and Services Administration United States Maryland Walter Wodchis Associate Professor University of Toronto Canada Ontario Sabrina Wong Professor University of British Columbia Canada British Columbia Kue Young Dean and Professor School of Public Health, University of Alberta Canada Alberta Judy Zerzan Chief Medical Officer Colorado Dept. of Health Care Policy and Financing United States Colorado AAFP, American Academy of Family Physicians; AHRQ, Agency for Health Research & Quality; AMA, American Medical Association; BC, British Columbia; CEO, Chief Executive Officer; CRCHUM, Centre de recherche du Centre hospitalier de l'Université de Montréal; CIHR-ICHR, Canadian Institutes of Health - Institute of Circulatory and Respiratory Health; EPC, ; FMAH, Family Medicine for America′s Health; FMA, Family Medicine for America′s; HHS, Health and Human Services; HRSA, Health Resources and Services Administration; ICRH, Institute of Circulatory and Respiratory Health; INESSS, Institut national d′excellence en santé et en services sociaux; NYU, New York University; PEI, Prince Edward Island; PICHI, Primary and Integrated Health Care Innovations; QC, Queens College; RN, Registered Nurse; SPOR, Strategy for Patient-Oriented Research; UC, University of Cincinnati; UCLA, University of California, Los Angeles; UNB, University of New Brunswick; VCU, Virginia Commonwealth University; VP, Vice President.
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