CMS to give big boost to primary care
Innovation Center launches new program that sees prospective payment as path to promoting better care coordination and meeting patients' social needs.
Health care reformers have long lamented the woeful state of primary care in the U.S. Underpaid and largely ignored by the larger profession, primary care physician practices receive just 7% of total health care spending even though they employ a third of all physicians.
Reformers have also long recognized that primary care physicians hold the key to improving patient outcomes, the patient experience and lowering the total cost of health care. The way they could achieve those lofty goals is by actively coordinating the care of their patients, helping them self-manage their chronic conditions, and addressing their social needs, which drive so much ill-health.
Medicare’s Innovation Center, created under the Affordable Care Act, has launched several pilot projects over the last decade designed to boost primary care. None has made a major dent in the current system of fragmented care.
But this past week, it launched a new project that looks, on the surface at least, to hold great promise. Starting a year from now, primary care physician practices in eight states will be able to participate in its new Making Care Primary program that will give them a flat fee (it’s not tied to fee-for-service medicine) to coordinate care with specialists; address behavioral health needs and tap into community networks that provide social services.
The program will be open to practices in eight states: Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, North Carolina, and Washington. It will operate on three tracks. For practices without experience in care coordination, it will give grants to build the infrastructure to train staff in chronic disease management, conducting social needs screening and managing referrals.
A second track will place participating practices in a 50/50 blend of prospective payments and fee-for-service payments with the expectation they will partner with social service providers and systematically screen for behavioral health conditions. An advanced track will move those practices to 100% prospective payments. The program will address health inequities by risk-adjusting the prospective payments for clinical and social factors.
I look forward to watching this model unfold since it ticks off all the boxes I’ve been writing about the last few years (see links below). I’m sorry to see it is only being opened to primary care practices in eight states. But given the fact that many of the Medicare patients most in need of care coordination services (those with multiple chronic conditions) are also dually eligible for Medicaid, close coordination between CMS and state Medicaid agencies is a must if the program is going to succeed.
As the Innovation Center said in its briefing paper, the states chosen met the criteria of “geographic diversity, health equity opportunity, population, current CMS Innovation Center footprint, generalizability to the rest of the Medicare population for model evaluation, and the ability to align with state Medicaid agencies.” My own state of Illinois clearly met all the criteria — except, perhaps, the last.
Here are some of my articles on primary care:
