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Analysis

Providers Applaud CMS' Primary Care Initiative

By John Commins  
   April 23, 2019

The Primary Cares Initiative got a warm initial reception from key providers groups, but many still have questions about the details of the proposal.

Provider associations are praising the Centers for Medicare & Medicaid Services' plans to launch five at-risk primary care models.

"Providing adequate financial support for high quality primary care must be an essential element of any strategy to improve the quality and affordability of our country's healthcare system," Gerald E. Harmon, MD, Immediate Past Chair of the American Medical Association Board of Trustees said in prepared remarks.

"Many primary care physicians have been struggling to deliver the care their patients need and to financially sustain their practices under current Medicare payments," Harmon said. "The new primary care payment models will provide practices with more resources and more flexibility to deliver the highest-quality care to their patients."

Health and Human Services Secretary Alex Azar unveiled the voluntary initiative on Monday, saying the CMS Primary Cares Initiative for Medicare and Medicaid beneficiaries would transform primary care to a value-based system that rewards physicians who keep patients healthy and out of the hospital.

The AMA also praised CMS for basing the new payment models on proposals developed by practicing physicians and incorporating recommendations from the Physician-Focused Payment Model Technical Advisory Committee.

"Secretary Azar has said that the best ideas for improving outcomes often come from individuals and organizations on the front lines of the health care delivery system, and we agree," said Harmon.

"PTAC has identified a dozen payment models developed by physicians that it believes merit testing or implementation by HHS, and we hope today’s announcement will be the first of many efforts to implement PTAC's recommendations," he said.

Related: CMS Launches Value-Based Primary Care Initiative With Downside Risk

Ashley Thompson, the American Hospital Association's senior vice president of public policy analysis and development, said the hospital lobby "appreciates CMS's continued efforts to create additional voluntary payment models for providers."

"We look forward to learning more about these new models and how they can support our collective efforts to improve the health and well-being of our patients and communities," she said.  

Don Crane, president and CEO of America's Physician Groups, called the initiative "a win for patients and the physician groups who care for them."

"For years, our members have demonstrated that patient-centered, integrated, and accountable care can address the low-quality, high-cost care that comes with a fragmented fee-for-service healthcare system," he said. "We’re very pleased to see that many of our recommendations for improving value-based care were adopted throughout these new models."

Crane predicted the initiative "will open the throttle on the movement from volume to value and improve the health of populations across America."

"We look forward to meeting with CMS to better understand how benchmarking will be implemented within these payment models," he said. "And we’ll be taking a closer look at the beneficiary component to see how that might impact both patients and their physician providers."

The Healthcare Leadership Council President Mary R. Grealy said the council is "encouraged by the administration's continued efforts to shape a Medicare program that focuses on improving care while, at the same time, containing costs."

"We applaud efforts to make the antiquated fee-for-service model a part of healthcare's past while ushering in a future that focuses on value, and putting the patient at the center, rather than volume of services," Grealy said.

Grealy said the initiative correctly focuses on seriously and chronically ill patients, who account for the greatest proportion of healthcare costs.

"We strongly support the continued movement toward coordinated care for this patient population and the new payment models’ incentives for providers to treat these high-need patients," she said.

Ann Greiner, president and CEO of the Patient Centered Primary Care Collaborative, commended HHS "for focusing on the centrality of primary care to achieve enhanced patient value."

"This is a major step in the right direction by the nation’s largest payer, one that promises to transform the role primary care plays in our national healthcare system," Greiner said.

Travis Broome, vice president for policy and ACO administration at the primary care provider Aledade, called the initiative "a smart step in the right direction, further moving healthcare away from fee-for-service and toward paying for better health outcomes."

Broome said the initiative shows that federal policymakers "recognize the leading role that primary care physicians play in a value-based health care system that better serves patients, providers, and payers alike."  

The Primary Cares Initiative was largely the brainchild of policy wonks at CMS' Center for Innovation, which was created under the Affordable Care Act.

HLC's Grealy said the initiative "underscores the importance of having a Center for Medicare and Medicaid Innovation, to have a testing ground in which new patient-centered models can be evaluated, advanced, and bring substantive improvement to patient care."

It's not clear what would happen to the CMMI—or how it would affect the primary care initiative rollout—if a federal appeals court sides with a Texas-led coalition of 20 state attorneys general who are challenging the constitutionality of the ACA.

“The new primary care payment models will provide practices with more resources and more flexibility to deliver the highest-quality care to their patients.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

Advocates say the initiative validates the emphasis on primary care as a fundamental component of the healthcare delivery system.

The initiative is largely the brainchild of CMS' Center for Innovation, which was created under the Affordable Care Act.

It's not clear what would happen to the CMMI—or how it would affect the primary care initiative rollout—if a federal appeals court sides with a Texas-led coalition of 20 state attorneys general who are challenging the constitutionality of the ACA.


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