If you are a big purchaser of health services you can align financial incentives with the goals. You recognize the value of good primary care (not just more of the same) and the need to provide funds for the work of effective primary care.
Whatever your payment model, your expectation is that the money is going for innovative work that achieves the desired results. You have claims data and risk-adjusted reporting that tells you if you're hitting the financial targets and you can use your typical quality data sets, but you're wondering "How do I reward the right PCPs?" This is a re-framing of the question "What behaviors in practice predict the desired outcomes?"
There are two big measure sets that have some link to new PCP behavior predicting outcomes: NCQA's PPC-PCMH(tm) and CMS's Meaningful Use. As you pour over the principles you're probably getting excited: they look very good and line right up with the goals. As you look into the actual rules you realize that both bog down in a great deal of minutia.
I've posted before on NCQA's PPC-PCMH(tm), so I'll provide a tiny window into CMS's MU standards.
Care coordination: "Perform at least one test of the certified EHR technology's capacity to electronically exchange key clinical information."
In the quality/reliability bucket: Sending reminders to patients @ preventive care: "More than 20% of unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period."
Neither of these measures are wrong or bad, they are just so disappointingly weak. If we set the national bar at MU's definition of care coordination we're not likely to accomplish very much. We should absolutely do these things, but can't we raise our sights a bit?
I suppose a payer could use one or both of these rule sets based on the assumption that this low bar is still an improvement but there are some who may want to aim a bit higher. I know this is an initial rule set and the intent is to up the ante over time. NCQA says the same thing regarding their PPC-PCMH(tm) tool. Are folks happy enough with our current state of health care that they're willing to tolerate this pace of change?
While we're waiting for more robust tools from these two important players it might make sense to consider how we might set a high bar now. Tools address the primary care practice's effectiveness as a source of care for all patients seem more logically aligned with large-area-under-the-curve change.
If you've read the literature supporting good primary care you might consider tools that measure good primary care:
These tools cut the core value of primary care: access, relationship over time, comprehensive services, care coordination. A good tool provides the practice with data on their performance directly linked to the outcomes and raises the bar from the current crop of weak and tangential measures.
There must be some groups ready for more targeted change. I've certainly heard from many PCPs that they're very interested in rule sets that make more sense.