Alternative payment models, including various flavors of "value-based payment," accountable care organizations, and CPC+ (and other hybrid PCMH payment structures) were viewed by many (including those of us in professional society leadership) as not only saving money and increasing quality, but also as a means of providing greater support to primary care and the patient-physician relationship, which were disadvantaged by the legacy fee-for-service based system. I would disagree with the conclusion that these payment models have been a complete failure, but they have not been as successful as expected, plus they introduced new problems, such as "metric fever" and workflows centered more around the payment model and less around the patient, as highlighted in the book.
Are these structural failures or failures of implementation? How would people redesign the payment system to support relational care?
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