At last week’s Bree Collaborative meeting we adopted an primary care recommendations as well as voted to adopt adding pediatric care to last year’s perinatal bundle.

Read our Perinatal Bundle | Read our Primary Care Recommendations

We have leaned into bundled payments to solve some of the quality issues for specific clinical services for a variety of surgical procedures. This guideline is our first non-surgical bundle. Our workgroup first met through 2019 to look at care and reimbursement for the gestational parent (the one giving birth) and then met mid-way through this last year through January to add pediatric care to the existing bundled framework. We know that the strongest predictor for the overall well-being of the infant is the well-being of the gestational parent. The early relationship between the infant and parent(s) is critical to build a lifelong foundation for health.  The continued separation of parent and infant health care service delivery and payment structures does not align with current best available scientific evidence.

Our guideline presents a payment model that includes prenatal care, labor and delivery, postpartum care, and pediatric care along with clinical components for internal quality tracking and performance metrics. For the newborn, we include care from delivery through 30 days post-delivery. We include specific details for the minimum three visits: newborn, 2-5 days of birth, and within 30 days of birth.

You can find all the materials from the workgroup meetings on our website here.

Issues around access to primary care providers and the need to reinforce our primary care system led us to spend 2020 defining, measuring, and discussing these quality issues. Primary care is the usual source of health promotion, disease prevention, and care for our acute and chronic health problems.  Despite being the cornerstone of our health care system, primary care suffers from low reimbursement compared to specialty and hospital care. This leads to not enough time being spent with an individual patient in the visit. Compounding the issue of low reimbursement is the fact that many of the activities expected of a high-performing primary care practice are not reimbursed by traditional fee-for-service payment approaches.

To address issues of limited access and uncertain definitions, we developed standards to develop a state-wide definition for primary care to support multi-payor payment reform. We recommend system- and individual-level changes to build a healthcare system that truly meetings the needs of a diverse population. Our goal is to foster a common understanding of primary care through defining primary care, discussing measurement of primary care, and outlining components of primary care that are impactful on population health.

You can find all the materials from the workgroup meetings on our website here.

Ginny Weir, MPH
Interim CEO, Foundation for Health Care Quality
Director, Bree Collaborative