I read with interest the recent Premise article by Dr Tevaarwerk, “Does the Longitudinal Family Physician Payment Model improve health care, including sustainability?” [BCMJ 2023;65:242-247]. The aims listed are laudable; indeed, who could argue with them?
However, it is doubtful they could be achieved simply by adjusting individual physician payment levels. As the author correctly notes, “[t]he new model has no incentives to build primary care teams, a way of increasing capacity at lower cost.” This is a fatal oversight. My working experience in 2000–2020 under a capitated blended-funding model (based on the Johns Hopkins Primary Care model and Dr Barbara Starfield’s ideas) suggests that by taking an organizational approach to funding, this missing incentive could be realized.
The province-wide network of small organizations (i.e., practices or clinics) is an ideal (and existing) framework for physician-led primary care teams. Direct funding to such group practices, based on several predetermined principles, would allow such organizations to arrange themselves to best deliver care within that funding envelope, using a mixture of physicians, nurses, and other providers best suited to that practice, location, and population. Patient volume and complexity become the drivers of revenue, creating market demand for patients, specifically elderly, complex patients. Outflow rules minimize the duplication of services. Suboptimal or delayed care is similarly penalized by market forces.
—Alister Frayne, MB ChB, MBA, CCFP, FCFP
This letter was submitted in response to “Does the Longitudinal Family Physician Payment Model improve health care, including sustainability?”
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