Providers, Execs Applaud Medicare’s Primary Cares Initiative

April 24, 2019 - Provider groups and healthcare executives are on board with Medicare’s new Primary Cares Initiative, which will shift primary care from fee-for-service to at-risk value-based reimbursement models starting in 2020.

“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’s (AMA) Board of Trustees, said in an official statement.

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

HHS Secretary Alex Azar and CMS Administrator Seema Verma made the Primary Cares Initiative announcement at the AMA’s Washington Office on Monday, saying the initiative is an historic value-based transformation for primary care.

Provider groups are especially commending the initiative’s Primary Care First (PCF) track, which includes two value-based reimbursement models for primary care providers.

READ MORE: Key Capabilities for Value-Based Reimbursement Models

“Primary Care First is a smart step in the right direction, further moving healthcare away from fee-for-service and toward paying for better health outcomes,” Travis Broome, vice president for policy and ACO administration at Aledade, stated in an email. “Today's announcement shows that Secretary Azar and Administrator Verma recognize the leading role that primary care physicians play in a value-based healthcare system that better serves patients, providers, and payers alike.”

PCF is a set of voluntary five-year payment model options that will reward providers for delivering high-quality care at lower costs, CMS explains. The regionally-based, multi-payer track will pay primary care practices a population-based payment along with a flat primary care visit fee to encourage providers to deliver value-based care, focus on patients over payment, and lower costs.

The track will also pay certain primary care practices higher payments for treating complex, seriously ill patients.

Developing a value-based payment model targeting the treatment of seriously ill patients is a win for the healthcare system, Mary R. Grealy, president of the Healthcare Leadership Council (HLC), said on the group’s website.

“One of the most encouraging aspects of the announcement today is the emphasis on the patients who account for the greatest proportion of healthcare costs, those with serious illnesses and multiple chronic conditions,” she said.  “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.”

READ MORE: Investing in Primary Care Delivers Value-Based Care Results

The Coalition to Transform Advanced Care (C-TAC) also praised the payment model option that rewards primary care providers for delivering high-value care to seriously ill patients and those who are suffering from complex chronic conditions.

“This model will be a critical component in the continuum of care and we are eager to focus our expertise and resources on bringing that continuum to life,” Tom Koutsoumpas, C-TAC co-chair and co-founder, said in an official statement.

PCF payment model options include elements of the alternative payment model proposal C-TAC submitted to an HHS committee dedicated to approving and testing physician-focused payment models.

The Primary Cares Initiative shows CMS’ commitment to advancing value-based care, several provider groups added.

“Giving even more physicians the option of participating in responsible payment models will open the throttle on the movement from volume to value and improve the health of populations across America,” Done Crane, president and CEO of America’s Physician Groups, stated on the group’s website.

READ MORE: Aligning Incentives for Providers, Payers Improves Primary Care

HLC’s president added, “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.”

The American Academy of Family Physicians (AAFP) also applauded CMS’ commitment to investing in primary care through the initiative. Recent research shows that primary care represents as little as two percent of total Medicare spending.

“For decades, research has demonstrated the relationship between primary care and improved outcomes, better overall health and longer life expectancy,” John Cullen, MD, AAFP president, 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.”

At first glance, providers groups are optimistic about the value-based reimbursement initiative aimed at primary care providers. But some industry experts and leaders are waiting on additional program details.

“America’s hospitals and health systems are committed to value-based care, and we appreciate CMS’s continued efforts to create additional voluntary payment models for providers,” Ashley Thompson, senior vice president of public policy analysis and development at the American Hospital Association (AHA), stated online. “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.” 

America’s Physician Group also looks forward to understanding how CMS will implement benchmarking within the payment model options under the Primary Care Initiative. The group also plans to further explore the beneficiary component to determine how it could affect patients and providers.