Welcome to The Partnership to Empower Physician-Led Care weekly newsletter, which includes news from our members, legislative and Administration updates, news clips, and studies about value-based care, primary care, and independent physicians.
HHS: (11/29) – HHS leaders published an article in Health Affairs, “Improving Health And Well-Being Through Community Care Hubs,” which outlines the role of coordinating health and social care within federal, state, local, and tribal governments, community based organizations, health care providers, payers, and public health entities to meet the needs of individuals within their communities. The article notes the importance and highlights examples of communities developing sustainable partnerships with physicians to support this coordination. This thought leadership is notable for future HHS policymaking.
CMS: (11/23) – CMS released the Performance Year (PY) 2021 financial and quality benchmark performance results for the 53 Direct Contracting Entities (DCEs) that participated in the Global and Professional Direct Contracting Model in Calendar Year (CY) 2021. DCEs in PY2021 generated approximately $119 million in gross savings and all 53 DCEs attained quality scores of 100 percent.
Aledade: (11/28) – Aledade released a podcast episode, Realizing the Full Potential of Primary Care in ACOs, which discusses the need to move to value-based care and change the payment structure, and reflects on the historical underfunding and undervaluing of primary care.
Newsweek: Healthcare Provider: Why Physician Leadership Matters in Healthcare (11/29) – Consolidation usually is followed by rounds of cost-cutting, cost standardization and standardization of practices. When physicians become employees, they typically are more likely to be told how many patients they must see, the hours they will work, how long each visit will last and how the practice is managed. This decreased autonomy can decrease engagement and increase burnout. Indeed, physician satisfaction with some of these arrangements has proven to be poor: a McKinsey study showed that 26 percent of physicians who joined a practice or health system expressed interest in returning to self-employment.
Medical Economics: Who will provide primary care? (11/29) – Any professional group representing primary care will tell you doctors are already feeling the strain of too many patients for too few physicians. In the end, there are just more patients in need of primary care than there are providers of any education level to provide it, according to experts. The only way to help patients is to think about primary care in new ways. “We need to be thinking about care teams, because it is not just one person going it alone. Teams may look a little different in rural areas. It’s not physicians versus NPs versus PAs; none of them practice in isolation. We need to put our attention on how we can create more robust teams, and that means NPs and physicians and PAs working together as well as working with other types of providers and health care support people.”
Becker's Hospital CFO Report: Hospitals, health systems see mergers as path to survival (11/29) – This year alone, 19 hospitals have closed or filed for bankruptcy due to the increasing financial issues they continue to battle, including declining inpatient volumes, decreasing reimbursements and the continued effects of the pandemic. As a result, many hospitals vulnerable to closure or bankruptcy are looking to survive by joining larger health systems, which are also viewing potential acquisitions with more skepticism, according to Vox. Despite the current financial climate in healthcare and a projected recession next year, many health systems are pursuing mergers and acquisitions to scale and reduce costs, provide additional care services and strengthen their footprint in certain markets.
Health Leaders: Business Group on Health: 7 Healthcare Trends for 2023 (11/29) – Pursuing affordability of services tops seven healthcare trends for 2023, according to the Business Group on Health. The trends are associated with the interplay of several factors, says Ellen Kelsay, president and CEO of the Business Group on Health. "While each trend relates to employer health and well-being strategies, they also exist against the backdrop of the global economy, workforce trends, innovation, and the policy and regulatory environment. As such, factors that range from provider labor shortages to the increased cost of healthcare will affect employers and employees alike in the year to come." To optimize cost savings, patient experience, and health outcomes, employers are expected to continue to adopt value-based payment models. Examples of popular value-based payment models include advanced primary care, high-performance networks, accountable care organizations, and centers of excellence.
Fierce Healthcare: Providers in Direct Contracting Model saved Medicare $70M in 2021, CMS reports (11/29) – The Direct Contracting Model saved Medicare $70 million in 2021 as the Biden administration plans a major overhaul to the value-based care program next year. The professional and global Direct Contracting Model will transition in 2023 to the ACO REACH Model. The ACO REACH Model will require participants to meet several provisions on promoting health equity, including the creation of a health equity plan. The model will also introduce a health equity benchmark adjustment to payments to help support entities on care delivery and coordination in underserved areas.
The Hill: Stop hospital consolidations to lower health care prices for all Americans (11/28) – In a newly released paper, we lay out pragmatic solutions for tackling hospital monopoly power, with an aim to lower costs for patients. To identify the prevalence of these practices, policymakers should direct the Federal Trade Commission and Department of Justice Antitrust Division to study these practices and endow the Federal Trade Commission with the authority to address hospital anti-competitive behaviors such as these. In addition, researchers and antitrust agencies should be empowered to focus on target areas needing federal competition enforcement through the regular publication and dissemination of a State Competition Index. Finally, Congress can promote the growth of new small businesses. The ban on new facilities participating in Medicare took away the possibility of hospital ownership from physicians. With recent research demonstrating that physician-owned hospitals can improve quality and lower costs, policymakers should support bills in the House and Senate to correct this error.
Medical Economics: U.S. health care a ‘very mixed picture’ with challenges for primary care, staffing (11/28) – Primary care availability is drying up in some parts of the nation. Even so, primary care accounted for more than half of medical physician office visits before the COVID-19 pandemic hit. The figures are part of the “2022 National Healthcare Quality and Disparities Report” published this fall by the U.S. Agency for Healthcare Research and Quality (AHRQ) under the Department of Health and Human Services. The report includes data on primary care health professional shortage area (HPSAs), communities with limited or no access to primary care. It would take at least 16,461 additional practitioners to fulfill the needs of the existing HPSAs, according to the federal estimates.
Med City News: Biden’s New Executive Order Could Usher in an Era of Fair and Equitable Drug Pricing (11/27) – Paying a price based on outcomes, known as value-based contracting or value-based purchasing, means that payers base their prices on how much the drug actually helps patients. Adopting value-based contracting is the only way we can see sustainable long-term lower consumer drug prices. Such a model, hopefully pushed into fruition by this executive order, will mean that the Inflation Reduction Act will usher in not an era of government price setting, but an era when drugs are equal in value to their price.
AJMC: Survey Illustrates High Receptiveness From Payers to Alternative Payment Models (11/24) – The Health Care Payment Learning and Action Network (LAN) recently released the results of its survey tracking the progress of payers and providers as they adopt value-based alternative payment models, as health care shifts from fee for service (FFS), volume-based care, to one based on value. The 2022 Alternative Payment Model (APM) survey was conducted from May to July 2022, with a total of 63 health plans, five FFS Medicaid states, and traditional Medicare participating. These health plans and states represented approximately 233,870,081 of the nation’s covered lives and 77.7 percent of the national market. APMs received 40 percent of health care payments, across all payer types. Subscription to risk-based models rose with one in five (20 percent) of payments in US health care ascribed to risk-based advanced payment models.
Fierce Healthcare: There's an 'arms race' in health tech. Who could be the next M&A target? (11/23) – Major retailers are extending their reach deeper into the care continuum, and it has major implications for how and where care is delivered and paid for as well as by whom. These "nontraditional players" are gaining traction and have the potential to grab as much as 30% of the $260 billion U.S. primary care market by 2030, according to a recent report from Bain & Company. As the primary care market heats up, there is speculation about which medical groups and primary care startups could be in the M&A crosshairs.
Fierce Healthcare: Chaotic work conditions during COVID helped foster clinician burnout (11/23) – During unprecedented, chaotic times in healthcare such as what the world went through during the COVID-19 pandemic, showing clinicians they’re valued and they’re not facing the carnage alone helps them avoid burnout and stop counting down the days until they quit. Those are two of the findings in a study in JAMA Health Forum that looked at physician burnout during the pandemic. “Given annual cost estimates of approximately $5 billion for burnout-related U.S. physician turnover, cost savings could be considerable,” the study said. “Clinicians may work more and burn out because they perceive no options to work less, suggesting it is the structure of U.S. healthcare that, in part, limits the ability to mitigate burnout. This study offers data to support targeted processes to bring sense to a health care system that wishes to preserve and sustain its workers.”