Rapid Prototyping Model for Healthcare Alternative Payment Models: Replicating the Federally Qualified Health Center Advanced Primary Care Practice Demonstration

Abstract

Innovation in healthcare payment and service delivery utilizes high cost, high risk pilots paired with traditional program evaluations. Decision-makers are unable to reliably forecast the impacts of pilot interventions in this complex system, complicating the feasibility assessment of proposed healthcare models. We developed and validated a Discrete Event Simulation (DES) model of primary care for patients with Diabetes to allow rapid prototyping and assessment of models before pilot implementation. We replicated four outcomes from the Centers for Medicare and Medicaid Services Federally Qualified Health Center Advanced Primary Care Practice pilot. The DES model simulates a synthetic population's healthcare experience, including symptom onset, appointment scheduling, screening, and treatment, as well as the impact of physician training. A network of detailed event modules was developed from peer-reviewed literature. Synthetic patients' attributes modify the probability distributions for event outputs and direct them through an episode of care; attributes are in turn modified by patients' experiences. Our model replicates the direction of the effect of physician training on the selected outcomes, and the strength of the effect increases with the number of trainings. The simulated effect strength replicates the pilot results for eye exams and nephropathy screening, but over-estimates results for HbA1c and LDL screening. Our model will improve decision-makers' abilities to assess the feasibility of pilot success, with reproducible, literature-based systems models. Our model identifies intervention and healthcare system components to which outcomes are sensitive, so these aspects can be monitored and controlled during pilot implementation. More work is needed to improve replication of HbA1c and LDL screening, and to elaborate sub-models related to intervention components.