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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2991

摘要内容如下：

医疗保险和医疗补助服务创新中心（CMMI）设定的目标是，到2030年，100%的传统医疗保险受益人成为责任医疗关系的一部分。缺乏有意义的财务激励、无法忍受或不可预测的风险、基础设施成本、患者参与、自愿参与和操作复杂性已被提供者和医疗保健服务机构视为参与的障碍或退出计划的原因。此外，大多数试行和实施的基于人群的总护理成本（Pb-TCOC）支付模式都侧重于初级保健医生的角色，即作为患者多方面护理团队的责任（即归属）领导者，以及作为“医疗社区”的市长，而没有明确专科护理医生的角色。成功地将提供者专家整合到Pb-TCOC模式中包括专家在实现全人、高价值护理方面的有意义的参与，其中所有提供者都有参与的经济动机；在整个护理过程或事件中，每个参与方都有明确的预期归属和明确界定的责任；有一个已知的护理归属过渡责任计划；有可操作的、透明的和及时的可用数据，并涵盖适当的数据开发和基本分析成本；并且存在对作为纵向护理计划的一部分的护理事件的管理的责任人或实体的预付款项。如果要鼓励专家加入TCOC模型以实现CMMI的目标，则应创建支付模型来解决这里提出的7个挑战。

英文原文如下：

Abstracts

The Centers for Medicare & Medicaid Services Innovation Center (CMMI) has set the goal for 100% of traditional Medicare beneficiaries to be part of an accountable care relationship by 2030. Lack of meaningful financial incentives, intolerable or unpredictable risk, infrastructure costs, patient engagement, voluntary participation, and operational complexity have been noted by the provider and health care delivery community as barriers to participation or reasons for exiting programs. In addition, most piloted and implemented population-based total cost of care (PB-TCOC) payment models have focused on the role of the primary care physician being the accountability (that is, attributable) leader of a patient's multifaceted care team as well as acting as the mayor of the "medical neighborhood," leaving the role of specialty care physicians undefined. Successful provider specialist integration into PB-TCOC models includes meaningful participation of specialists in achieving whole-person, high-value care where all providers are financially motivated to participate; there is unambiguous prospective attribution and clearly defined accountability for each participating party throughout the care journey or episode; there is a known care attribution transition accountability plan; there is actionable, transparent, and timely data available with appropriate data development and basic analytic costs covered; and there is advanced payment to the accountable person or entity for management of the care episode that is part of a longitudinal care plan. Payment models should be created to address the 7 challenges raised here if specialists are to be incented to join TCOC models that achieve CMMI's goal.

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