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KMID : 1040120170030020151
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Evidence and Values in Healthcare
2017 Volume.3 No. 2 p.151 ~ p.158
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Research on U.S. primary care pilot project operations: Comprehensive Primary Care Initiatives (CPC) with the Center for Medicare & Medicaid Innovation (CMMI)
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Lee Eun-Ji
Kim Hyeong-Su
Kim Kye-Hyun
Yoo Bit-Na
Kim Hee-Sun
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Abstract
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Chronic diseases are a leading cause of death worldwide. Responsively, a good primary care system is known to be effective for the management and prevention of chronic diseases. The US runs a pilot project, a unified system for the planning, implementation and evaluation of primary care that establishes the Center for Medicare & Medicaid Innovation (CMMI) under the Centers for Medicare & Medicaid Services (CMS), which is the public insurance management institution. As the main agent and research institute of the health care system pilot project, CMMI develops the models for health care service delivery and an expense payment scheme, operates business, and evaluates performance both quantitatively and qualitatively. The Comprehensive Primary Care Initiatives (CPC) has been evaluated as the most successful payment model of all the pilot projects of CMMI. In order to enable health care practices to exert 5 comprehensive primary care functions based on a team system, CMMI provides them with a related payment system.
CMMI also has initiated quantitative and qualitative evaluations on the improvement of primary care functions, patient experience, and utilizations. These evaluations have presented meaningful project performances. The reality is that the overall management of the primary care pilot project in Korea is poor due to ineffective communication between those involved in project planning, implementation and evaluation. To improve the quality of the project, there is a need to consider the unification of implementation and evaluation systems that exist in Korea.
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KEYWORD
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Center for Medicare & Medicaid Innovation, Comprehensive Primary Care Initiatives, Primary Health Care
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