The crown of the building blocks is the template of the future. Few practices have achieved this ultimate goal: a daily schedule that does not rely on the 15-minute in-person clinician visit but offers patients a variety of e-visits, telephone encounters, group appointments, and visits with other team members. Clinicians would have fewer and longer in-person visits and protected time for e-visits and telephone visits.
With a team empowered to share the care, clinicians would be able to assume a new role—clinical leader and mentor of the team. Full implementation of this future template requires payment reform that does not reward primary care simply for in-person clinician visits.
Some practices are receiving non–visit-based care coordination and pay-for- performance dollars in addition to fee-for-service reimbursement, payments that begin to support new modes of patient encounters. More transformative is to eliminate fee-for-service payments altogether and pay for primary care on a risk-adjusted comprehensive fee per patient with adjustments for quality and patient experience.
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