Provider Groups Initially Enthusiastic About CMS’ Primary Care Payment Proposals

April 23, 2019
But are enough primary care groups ready to participate in models with significant risk?

On April 22, the U.S. Department of Health and Human Services announced a new set of voluntary value-based payment models for primary care physicians under the label “Primary Cares.” Clearly there are details to be worked out about benchmarking methodology and risk adjustment design. But thought leaders, provider groups and medical associations were generally enthusiastic in their initial responses.

One path of the new payment model, called Direct Contracting, allows larger, sophisticated organizations to take full accountability for their patients at a local level.

 America’s Physician Groups, an association that represents more than 300 medical groups already involved in value-based contracting, called the approach a win for patients and the physician groups who care for them. “We’re very pleased to see that many of our recommendations for improving value-based care were adopted throughout these new models,” said Don Crane, APG’s president and CEO in a prepared statement. “We look forward to meeting with CMS to better understand how benchmarking will be implemented within these payment models. And we’ll be taking a closer look at the beneficiary component to see how that might impact both patients and their physician providers.”

Blair Childs, senior vice president of public affairs for Premier, issued a statement saying the Direct Contracting model has a number of elements for which Premier has advocated over the years, including allowing primary care capitation and global budgets for providers who are ready for greater risk. “We’re also encouraged that the models will provide a quality bonus, coordinate with PACE and Medicaid, focus on chronic care and allow a testing year for participants.” Like APG’s Crane, Childs said Premier is looking forward to getting more details and helping CMS refine the models, particularly to ensure that the approach to benchmarking and addressing overlap with existing models enables their success.

 The Primary Care First Initiative allow small physician practices to move away from fee for service and take on some downside risk.

John Cullen, M.D., president of the American Academy of Family Physicians, applauded the new payment models. "For decades, research has demonstrated the relationship between primary care and improved outcomes, better overall health and longer life expectancy,” he said in a statement. “Recent research has shown how little investment Medicare makes in primary care. Today marks an important step toward recognizing the importance of primary care by developing payment models that value primary care. We look forward to working with CMS and CMMI on testing these new models as we continue our pursuit of a health care system built on a strong foundation of primary care."

On Twitter, Atul Gawande, M.D., CEO of Haven, the new company set up by Amazon, JPMorgan and Berkshire Hathaway, called the announcement a big deal. He noted that it creates a flat, per-patient monthly payment option for primary care providers, which means enabling using telehealth, health coaching and other innovations.

 Also on Twitter, Travis Broome, vice president for policy and ACO administration at physician-led ACO company Aledade, called Primary Care First an excellent evolution of CPC+. “A true move away from FFS, true administrative burden reduction (barring unexpected paperwork related to the prospective payment) and alignment with the right measures. If it can be coupled with MSSP, home run,” he wrote.

In making the announcement, HHS Secretary Alex Azar had called this “the pivotal hockey stick moment in paying for value in health care.” Writing on Evolent Health’s website, Ashley Ridlon, the company’s vice president of health policy, said, “Evolent hopes he's right, and that more providers are at a stage where they are ready to participate in models with significant risk—particularly the kind embedded in Direct Contracting. While there is cause to be optimistic, there are also reasons to hedge against the projections. Providers and other eligible entities will need to make careful assessments of the relative value of these models with an eye to the future, anticipating a continued move away from traditional fee-for-service Medicare.”

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