Volume 3 Issue 4 | May 2019
HCCInsights
Special Edition - Payment Reform
The CMS Primary Cares Initiative
Empowers Patients and Providers to
Drive Better Value and Results
On April 22, 2019, in a conference room in Washington DC, a small crowd of stakeholders including HCCI's CEO Dr. Tom Cornwell, MD along with members of the press were invited to hear an announcement which house call providers have been working toward and anticipating for more than 15 years. Alex Azar, Secretary of the U.S. Department of Health and Human Services along with Seema Verna, Administrator of the Centers for Medicare & Medicaid Services (CMS), and Adam Boehler, CMMI Senior Advisor to the Secretary announced the "CMS Primary Cares" initiative to empower patients and providers to drive better value and results.

According to the press release, " Empirical evidence shows that strengthening primary care is associated with higher quality, better outcomes, and lower costs within and across major population subgroups. Despite this evidence, primary care spending accounts for a small portion of total cost of care, and is even lower for patients with complex, chronic conditions.” It is with those patients that home-based primary care can make such a significant difference – both in the patient and caregiver experience and in cost reduction. Many primary care providers also find the home setting preferable as it allows them to develop deeper relationships with their patients – one of the factors identified as an important part of this new initiative.

For more information, go to HCCI News
What Does Expanding Access to Home-Based
Primary Care Mean to These Stakeholders
Providers
  • Greater patient satisfaction
  • Greater focus on patients
  • Creates a more financially stable business model
  • Ability to observe patients in their home setting
  • Consistent revenue stream
  • Rewards for keeping patients healthy
  • Less red tape and paperwork
Health Systems
  • Greater patient satisfaction
  • Opportunities to partner with primary care and HBPC
  • Reduced 30-day readmissions penalties
  • Improved margins for HBPC
  • Greater rationale for starting a house calls program
Payers
  • Healthier members
  • Reduces the number of unnecessary ED visits
  • Reduces hospital admissions and related payouts
  • Enhanced cooperation, collaboration and shared learning between Medicaid, Medicare and private insurance
Patients & Caregivers
  • Increased access to providers
  • Coordinated care team
  • Increased patient satisfaction
  • Decreased hospitalizations
  • Reduced out-of-pocket costs
  • Better outcomes linked to improved adherence to treatment plans
  • More consistent care
  • More face time with doctors
Path 1
Primary Care First:
Foster Independence, Reward Outcomes
Primary Care First is a set of voluntary five-year payment model options that reward value and quality by offering innovative payment model structures to support delivery of advanced primary care. In response to input from primary care clinician stakeholders, Primary Care First is based on the underlying principles of the existing CPC+ model design: prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes.

Why develop a new model based on the underlying principles of the CPC+ model?
Primary care is central to a high-functioning healthcare system and thus, there is an urgent need to preserve and strengthen primary care as well as a need for support of serious illness care services for Medicare beneficiaries.

Primary Care First addresses these needs by creating a seamless continuum of care and accommodates a continuum of interested providers. The payment options test whether delivery of advanced primary care can reduce total cost of care, accommodating practices at multiple stages of readiness to assume accountability for patient outcomes. Primary Care First will focus on advanced primary care practices ready to assume financial risk in exchange for reduced administrative burdens and performance-based payments.

Path 2
Direct Contracting
Direct Contracting (DC) is a set of voluntary payment model options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). The payment model options available under DC create opportunities for a broad range of organizations to participate with the Centers for Medicare & Medicaid Services (CMS) in testing the next evolution of risk-sharing arrangements to produce value and high-quality health care. Building on lessons learned from initiatives involving Medicare Accountable Care Organizations (ACOs), such as the Medicare Shared Savings Program (MSSP) and the Next Generation ACO (NGACO) Model, the payment model options available under DC also leverage innovative approaches from Medicare Advantage (MA) and private sector risk-sharing arrangements. 

DC creates three payment model options for participants to take on risk and earn rewards, and provides them with choices related to cash flow, beneficiary alignment, and benefit enhancements. The payment model options are anticipated to appeal to a broad range of physician practices and other organizations because they are expected to reduce burden, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in Medicare FFS or CMS Innovation Center models. In an effort to further refine one proposed payment model option, CMS is seeking additional input from the public through a Request for Information (RFI) regarding their perspectives on specific design parameters for a Geographic Population-Based Payment (PBP) option.

CMS Primary Cares Initiative Overview
Need a handy reference or want to share news of the CMS Primary Cares Initiative with a colleague? Download this one-sheet from CMS which provides an executive summary of the five new payment model options .

See HCCI at AGS19 Booth #317
If you're attending the American Geriatrics Society Annual Meeting this weekend in Portland, Oregon, be sure to stop by the HCCI booth #317. Our resident Practice Improvement Specialist will be on hand to answer your questions.
Upcoming 2019 HCCI Workshop
Register for our June Workshop
This two-day foundational workshop is designed for learners who are considering or who are relatively new to offering home-based primary care (HBPC) services for patients with complex medical conditions.

June 13-14, Schaumburg, IL