Two important publications on primary care payment models were released in 2021 – the Implementing High-Quality Primary Care Report from the National Academies of Science, Engineering, and Medicine (NASEM) and the Innovation Center Strategy Refresh from the Center for Medicare and Medicaid Innovation (CMMI). Both documents provide insights on improving quality of care and advancing practice transformation, as well as objectives that can be used to further inform the College’s advocacy platform, most of which align with ACCP’s advocacy approach.

NASEM’s Implementing High-Quality Primary Care Report

NASEM formed the Implementing High-Quality Primary Care Committee in 2019, tasking it with developing an implementation plan for high-quality primary care in the United States. ACCP member Mary Roth McClurg, who served on this NASEM committee, provided an overview of this visionary report at the 2021 ACCP Annual Meeting advocacy session, Advancing the Profession by Influencing Policy: ACCP’s Advocacy Efforts Beyond Capitol Hill. The NASEM report details objectives and actions targeting primary care stakeholders and balancing national needs for scalable solutions while allowing for adaptations to meet local needs. The report defines high-quality primary care as follows:

The provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams who are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships with patients, families, and communities.

NASEM’s Implementation Objectives to Make High-Quality Primary Care Available

1. Pay for primary care teams to care for people, not doctors to deliver services.
2. Ensure that high-quality primary care is available to every individual and family in every community.
3. Train primary care teams where people live and work.
4. Design information technology that serves the patient, the family, and the interprofessional care team.
5. Ensure that high-quality primary care is implemented in the United States.

Of note, under the third objective, “Train primary care teams where people live and work,” the report calls for increased funding and expanded settings for training. Targeted actions include modifying GME (graduate medical education) funding to support the training of all members of the interprofessional primary care team, including nurse practitioners, pharmacists, physician assistants, behavioral health specialists, pediatricians, and dental professionals. This call for funding has promising implications to support the expansion of postgraduate pharmacy residency programs.

CMMI’s Innovation Center Strategy Refresh

In considering the lessons learned from its first decade and over 50 CMMI models, CMMI issued a strategy refresh for the next 10 years of value-based care that will improve the health system for all patients. CMMI is realigning its priorities to drive a delivery system toward meaningful transformation, including focusing on equity, paying for health care according to value to the patient instead of volume of services provided, and delivering person-centered care that meets people where they are.

Five strategic objectives will guide CMMI’s implementation of its vision:

1. Driving Accountable Care
   Aim: Increase the number of people in a care relationship with accountability for quality and total cost of care.
2. Advancing Health Equity
   Aim: Embed health equity in every aspect of CMMI models and increase focus on underserved populations.
3. Supporting Innovation
   Aim: Leverage a range of supports that enable integrated, person-centered care such as actionable, practice-specific data; technology; dissemination of best practices; peer-to-peer learning collaboratives; and payment flexibilities.
4. Addressing Affordability
   Aim: Pursue strategies to address health care prices and affordability and reduce unnecessary or duplicative care.
5. Partnering to Achieve System Transformation
   Aim: Align priorities and policies across CMS, and aggressively engage payers, purchasers, providers, states, and beneficiaries to improve quality, achieve equitable outcomes, and reduce health care costs.

Alignment with ACCP’s Advocacy Platform

The ACCP Advocacy Platform provides a descriptive framework for the principal areas of advocacy conducted by ACCP and is designed to align with the College’s strategic plan. ACCP’s advocacy priorities primarily include the following:

• Positioning clinical pharmacists to lead the adoption and integration of medication optimization in all practice settings, with a focus on team-based, patient-centered care that is continuous, coordinated, comprehensive, evidence-based, effective, and safe
• Advancing the implementation of high-fidelity comprehensive medication management (CMM) through advocating for payment reform and supporting innovation and practice transformation
• Promoting the value of clinical pharmacists in team-based patient care, education, and research through work with both intra- and interprofessional organizations within pharmacy or other health care organizations

ACCP’s advocacy priorities are consistent with all five of NASEM’s proposed implementation objectives for accessible high-quality primary care, but they particularly align with the first objective, “Pay for primary care teams to care for people, not doctors to deliver services.” ACCP’s payment reform initiatives focus on moving toward value-based payment models, and interprofessional work with organizations such as the Primary Care Collaborative and the Get the Medications Right Institute are a major part of this advocacy approach for payment reform. With its efforts to advance CMM provided as part of a coordinated health care team, ACCP also supports the second objective of ensuring equitable access to high-quality primary care by leveraging the expertise of integrated clinical pharmacists in team-based environments to improve team and workforce efficiency. Similarly, ACCP’s advocacy to build sustainable models to integrate clinical pharmacists as accountable members of the care team for improving outcomes, enhancing patient access to higher-quality services, and reducing total costs of care is consistent with CMMI’s strategic objectives in its next decade of evaluating alternative payment models.