Although the overall increase in health care costs in the United States has slowed recently, there still is an overwhelming consensus that the cost of health care in this country is unsustainable and more must be done to improve the quality of care. In response to this growing crisis, public and private payers have launched scores of innovative health care delivery and payment models designed to reward the value of health care services instead of the volume of services.

"We all agree that family physicians are among the most valuable people on the planet," he adds.

Nichols, like other analysts, describes primary care as the "linchpin of patient engagement." Most of the emerging payment and delivery models attempt to strengthen and incentivize primary care as a way of controlling costs and improving care, he says.

In fact, many of the nation's largest health payers have launched initiatives, such as the patient-centered medical home (PCMH), in local, regional and statewide markets, either separately or in conjunction with state programs to form multipayer collaboratives. These private payers include UnitedHealthCare, CIGNA, WellPoint Inc., Aetna, Humana, and Blue Cross and Blue Shield.

The ability of primary care to deliver on the promise of improved care, greater access and better controlled costs is well known and documented, fueling increased interest and investments in primary care. North Carolina's Medicaid managed care program, Community Care of North Carolina (CCNC), serves as one of the most potent examples of how a primary care-based delivery model can restrain growth in health care costs and improve care.

CCNC uses physician-led networks and the PCMH to provide care to the state's Medicaid patients. The program started with nine pilot projects covering 250,000 Medicaid enrollees in 1999 and has since expanded to 14 physician-led networks, 4,500 primary care physicians, and more than 1,400 medical homes that cover the entire state and provide care to 1.1 million enrollees.

According to North Carolina officials, CCNC has saved the state more than $1 billion in Medicaid costs during the past several years, emerging as an influencer of quality initiatives in North Carolina and a model for other states to consider.

For example, the Affordable Care Act created the CMS Center for Medicare and Medicaid Innovation, (CMMI) to develop and test innovative health care payment and delivery models that slow Medicare and Medicaid cost growth, as well as costs for the Children's Health Insurance Program.

During the past several months, the CMMI has launched various innovations, including the Comprehensive Primary Care initiative, a pilot program that has CMS working with commercial and state health insurance plans to support primary care practices that deliver coordinated and seamless care based on the tenets of the PCMH.

The voluntary initiative is scheduled to begin as a demonstration project in seven health care markets across the country. The 500 participating primary care practices will be paid based on a blended payment model that combines fee-for-service (FFS) with a per-patient, per-month care coordination fee ranging from $8 to $40. Participating practices also have an opportunity to participate in shared savings from the project.

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Family Physicians Are 'Linchpin' of Health Care Reform Efforts