Table 1.

Brainstorming Themes Regarding Payment Discussed at the 2016 Starfield Summit

Themes of Starfield Summit Participants' Discussion on PaymentRepresentative Statements Reflecting Theme
There is currently no streamlined, organized system of payment for healthcare.• Working with eighty different payers is difficult on a practice.
• Different payment models serve to fragment our work by turning each aspect of healthcare into a separate transaction.
Barriers and silos hamper innovative payment models.• The problem of a reductionist, disease-centered paradigm affects specialties as well as primary care.
• We need to redefine the buckets of how we pay for social services and healthcare, with no walls between the issues that drive health, including upstream causes.
• It is hard to innovate within regulatory environments that narrowly define healthcare.
Payment models must support, and be supported by, appropriate data measurement, data collection, and delivery infrastructure.• How do we know when primary care is doing a good job?
• We need good evidence on what makes a difference for the health of patients and populations.
• We need payment models that support implementation of new effective services.
Effective payment for primary care would pay for accessibility, comprehensiveness, continuity, and coordination.• Payment needs to honor the patient-provider relationship…and be structured around ways providers can be held accountable.
• How we define primary care is currently the sum of our fee-for-service diagnosis codes.
• Primary care needs to take accountability for population health and advocate for a payment system that reflects this.
Payment needs to be flexible so that clinics, teams, and health systems can use global payments to meet patients in innovative ways and address population health.• The population health aspect of the triple aim lies almost entirely outside of the health system as it currently exists.
• Mandated investments in primary care in Rhode Island shows you can bend the cost curve with a global per-member-per-month flexible payment on a large scale.
An effective payment system needs to be risk-adjusted on the population level, rather than individual patients.• Risk adjustment is necessary to prevent further marginalization of vulnerable populations.
Budgets for primary care need to include interventions that address the social determinants of health.• Social determinants of health are not just things that poor people face, they are a problem for everyone.
Why is there not time for pro-active case management by clinicians?
• Need to address all the things that our patient's struggle with to create health.