Connecting specialty practices with primary care.

47 Background: Public and private payers are beginning to adopt alternative payment structures that call for greater attention to patient-centered care and quality improvement activities (CMMI 2015; MACRA 2015). The National Committee for Quality Assurance (NCQA) developed standards for Patient-Centered Specialty Practice based on American College of Physicians principles. The report describes achievement on the standards among an initial cohort of recognized physicians.

METHODS: We analyzed practice characteristics and determined how practices performed on each of the 21 elements in the PCSP program by showing the percent of practices scoring less than 50% of points, or 100% of points (i.e. full credit) for each element.

RESULTS: One third of the 91 practices recognized in the first year of the program are Oncology/Hematology. Overall, about half of recognized practices have more than 5 clinicians and half are physician-owned (52%). Most specialty practices achieved full credit on having key clinical data in structured fields and using electronic prescribing. More than 75% of practices also achieved full credit for providing culturally and linguistically appropriate services, providing information about specialist visits back to primary care and providing patients/families information about the role of the specialist and coordination of care. Tracking of referrals to secondary specialists was most challenging, with only 6% of practices earning full credit. Only 34% of practices received full credit for coordinating care transitions from hospitals and other facilities; most practices did not even receive half credit. Measuring and improving performance was also challenging for all practices. Compared to other specialties, oncology/hematology practices were less likely to achieve full credit on the following elements: electronic access, measure patient/family experience, patient information, and care planning and support self-care. However, they performed better on documenting clinical data than other specialty practices.

CONCLUSIONS: Specialty care practices have started to implement the patient-centered care model. Research to identify which components of the model have the greatest impact on outcomes is needed.