There is understandable excitement and buzz around the announced plans by the Centers for Medicare and Medicaid Services to further realign incentives for primary care physicians with a bold test of its Comprehensive Primary Care Plus model.
It’s another step down the road to value-based care, a seismic shift away from the fee-for-service mentality that has dominated healthcare delivery, and reimbursement, for decades.
At its essence, the new CPC+ program espouses changes that absolutely must happen in healthcare in the U.S., and which physicians can and should lead. In the new value-based care economy, there’s significant value in physicians working with patients to give them personalized care, proactively monitoring conditions that could be prevented. That can help eliminate needless pain and suffering, and also wring cost out of the system.
The program aims to:
- Support patients with serious or chronic disease to achieve their health goals.
- Give patients 24-hour access to care and health information.
- Deliver preventive care.
- Engage patients and their families in their own care.
- Work with hospitals and other clinicians, to provide better coordinated care.
And CMS is looking to involve other payers in the experiment as well, using its market strength to have other partners in the program to expand the concept.
CPC+ is on a fast track, and that causes concerns for many. On April 15, it begins accepting applications from payers to participate in the program. It’s looking for 5,000 physician practices to participate, and they can apply from July 15 to September 1.
Realigning incentives in healthcare has been challenging, particularly in making the transition from volume to value. They are completely different directions in many ways, and it’s difficult for provider organizations to make the shift without taking on significant risk, in the short term. There’s little margin for error, with the financial pressures that providers now face.
No doubt, those experimenting with the transition will be taking on bigger risks. Initial forays by those testing accountable care had mixed results. Of the 32 organizations that signed up for the Pioneer ACO Model program in 2012, only nine still participate.
To give this important new approach the best chance to succeed, several key areas must be addressed, with program designers adjusting the program over time to give providers the time necessary to make adjustments.
Information technology. Many key targets of CPC+ will rely on IT systems for support. Physicians will need to draw on IT capabilities to improve their ability to communicate with patients, identify those who are at risk, and to exchange information with others in the care community.
While physicians are increasingly comfortable with technology, many of these uses lie beyond their current experience with technology, and CPC+ requires them to do more than what existing electronic health record systems and telehealth services are capable of delivering at this time. For example, many aspects of information exchange are still at very basic levels, and coordination of care implies an ability to swap information back and forth into health records that does not exist.
Process and workflow change. CPC+ is aiming at practices to step up their game in communicating with patients, with a level of availability that carries potential expense and increased workloads. Further, practice redesign will be necessary, because most physician practices have a history of responding reactively to patient requests for care, which is a world away from proactively caring for a population of patients.
While it would be hard to find a physician who would not aspire to the principles of CPC+, financially undertaking the transformation of care that’s necessary will be challenging, particularly for stand-alone physician practices.
Risk tolerance. Hand-in-hand with practice redesign is the willingness of organizations to take on increased risk inherent in a shift of payment models. Practices, already slammed with the responsibilities of providing care and keeping the doors open, may need consultative help with making this transition.
There’s precedent for this—the shift to the Meaningful Use program was greatly aided by the Regional Extension Centers, which supported tens of thousands of physicians in making the shift to electronic health records. A shift in practice as important as PCP+ suggests deserves no less support.
Operating in two worlds. Until details of the PCP+ become more evident, it’s likely that the healthcare industry will be operating with both a shrinking fee-for-service component and a value-based component. This dichotomy is challenging and expensive, particularly for practices that might be seeing patients from both persuasions. Reimbursement for practices making the shift to PCP+ should reflect the added risk and costs of potentially operating under both models.
Moving to value-based care is recognized as an important shift. We shouldn’t underestimate the cost, and we shouldn’t be miserly in funding the transition, if we’re serious about making it succeed.
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