The American Academy of Family Physicians (AAFP) is urging the Department of Health and Human Services (HHS) to increase alternative payment model participation opportunities, align models across payers, and ensure physicians caring for rural and underserved populations can successfully participate in APMs.
AAFP’s July 27, 2022, letter to HHS Secretary Xavier Becerra is in response to a request for information (RFI) on HHS’ Initiative to Strengthen Primary Care (PC). It includes a series of recommendations for increasing investment in primary care and addressing the administrative requirements that drive care delays and physician burnout.
AAFP says that because the fee-for-service model has continuously failed to support and invest in primary care, the organization has long advocated for acceleration of the transition to value-based care. APMs have reduced utilization of emergency department and acute care services and improved patients’ health outcomes. “Unfortunately, a dearth of PC models and the inadequacy of FFS payment rates are undermining the transition to value-based care. Because most APMs are designed based on FFS payment rates, modernizing FFS payment for PC is one essential strategy for support physicians’ transition into value-based care,” the letter said.
The AAFP also recommends implementing a stable suite of multi-payer APMs that are appropriate for practices with varying levels of experience taking on financial risk and assist practices to transition to more advanced APMs over time.
“Model features such as upfront access to capital, prospective payment, risk adjustment for clinical and social factors, and targeted technical assistance enhance patients’ access to high-quality, continuous PC and strengthen practice capabilities that improve quality and reduce health care spending, AAFP noted. “We further encourage coordination across Medicare, Medicaid, CHIP, marketplace plans, and commercial payers to harmonize requirements and quality measures. Aligning models across payers and embedding equity as a shared aim regardless of the patient population will foster greater physician participation and resource practices more efficiently to ensure all patients receive high-quality, affordable, patient-centered care.”
Among other issues, AAFP also touched on the sharing of health data. “The ongoing lack of interoperability across our health system and lack of standardization across EHR platforms inhibits effective information sharing and care coordination," the organization said. "Patients also struggle to access their own health data. HHS must work to improve information sharing from hospitals, specialists, and other care team members with PC physicians."
The AAFP also urged HHS to work with its agencies to ensure that the regulations governing the sharing and protection of patients’ health information are harmonized to meaningfully improve patients’ access to their health data and advance interoperability while also safeguarding patient privacy and security.
Prior authorization (PA) continues to be a leading cause of physician burden, and the AAFP is strongly supportive of efforts to reform and streamline the PA process. AAFP says it supports HHS’ efforts to streamline PA by advancing electronic PA standards. It says comprehensive PA reform is needed to reduce the volume of PA and ensure patients’ timely access to care, including clear guidelines for PA requirements and timely responses from insurance plans.
