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CMS Primary Cares: 5 Steps to Assess Your Readiness

Analysis  |  By Steven Porter  
   May 09, 2019

Despite the benefits of primary care, there are some important steps healthcare incumbents should take in deciding whether and how to participate.

Organizations that are eligible to participate in the new CMS Primary Cares Initiative models have a big determination to make: whether now is the right time.

For organizations like Austin Regional Clinic, the decision would be easy, says Norman H. Chenven, MD, founding CEO for the Texas-based organization and vice chairman of the Council of Accountable Physician Practices. The multispecialty group of 320 physicians, most of them primary care physicians, has already been investing heavily in its value-based readiness for the past decade, with primary care at the center, he says.

"When patients do not have real engagement with their primary care physician, they may think they're getting the greatest care in the world" because they have their own personal lineup of specialists, Chenven says.

"The truth is what they have is very fragmented, disconnected, and possibly even dangerous care," he adds.

Investments in primary care have been shown to improve health outcomes, but primary care services have represented less than 5% of Medicare fee-for-service spending, according to a recent RAND study.

Related: Medicare Just Invited More Competitors Into Value-Based Primary Care

Related: Related: 34% of Healthcare Orgs Report Strong or Moderate ROI on Value Investments

Report: Setting the Right Pace With Value-Based Readiness

Despite the established benefits of primary care and the promising signs around the CMS Primary Cares Initiative, there are some important steps for health systems, provider groups, and other incumbents to take in deciding whether and how to participate:

1. Evaluate your existing contracts

If you are currently participating in the Medicare Shared Savings Program or another model, consider whether that is the best way to monetize the value you bring, says Dennis K. Butts, Jr., MBA, a managing director in Navigant's value transformation practice. A study by Navigant last year found that many ACOs are losing money. But your decision on whether to move to a Primary Care First (PCF) or Direct Contracting (DC) model depends on how it compares to what you have.

2. Assess your infrastructure.

Whether you have a long list of existing value-based contracts or not, you should ask yourself if you have made the necessary investments (or can muster the resources and will to make the investments in the near term) to support a value-based primary care undertaking, Chenven says. In addition to needing capacity for enhanced healthcare services and a powerful electronic health record system, you will need leaders in place at both the executive and physician levels, he says.

3. Gauge your PCP alignment.

Your primary care physicians and other groups may soon have new partnership opportunities, so don't take them for granted, Butts says. Be sure to engage them up front and bring them into conversations about the strategy, he adds.

4. Define a comprehensive strategy.

This value-based primary care initiative will be just one piece of each participating organization's Medicare business, so you should think of it in terms of a spectrum that includes fee-for-service, Medicare Advantage beneficiaries, and others, Butts says. Focus your energy on "no-regrets" strategies that will benefit Medicare beneficiaries across all those contracting vehicles, he says.

5. Embrace your tech-driven potential.

That may mean embracing a partner's technological expertise. If another organization can build a better app than you or facilitate telemedicine more effectively, don't be too quick to think of them purely as a competitor, Butts says.

Editor's note: This story is a sidebar to "Medicare Just Invited More Competitors Into Value-Based Primary Care."

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.

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