Pusyankes: A Conceptual Framework for Integrated Primary Care Combining People-Centered Medical Home, Population Health Management, and Value-Based Health Care in Indonesia’s JKN Context
Keywords
JKN people-centered medical home population health management primary care model value-based health careAbstract
Background: Despite enrolling over 278 million members, Indonesia’s National Health Insurance (JKN) allocates only 11.2% of expenditure to primary care, which lacks the organizational features required to generate system-level benefits. No existing framework integrates People-Centered Medical Home (PCMH), Population Health Management (PHM), and Value-Based Health Care (VBHC) within the JKN context. Objective: This study introduces Pusyankes as an integrated primary care model and distinguishes between nominal and functional primary care. Methods: A three-stage conceptual development approach was applied: synthesis of PCMH, PHM, and VBHC literature; gap analysis against JKN structural constraints; and operational specification to generate testable predictions. Results: Pusyankes comprises five dimensions: team-based longitudinal care (PCMH), proactive three-tier population management (PHM), hybrid VBHC financing projecting IDR 22–32 million/month per 2,000-member panel, a seven-domain performance system, and a phased implementation pathway. Three testable predictions are proposed: physician income viability within 24 months, ≥15% reduction in avoidable referrals, and ≥20% improvement in chronic disease outcomes. Conclusion: Pusyankes provides a structured pathway to transform nominal primary care into functionally effective delivery. Prospective pilot evaluation is required to validate its impact within the JKN system.
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