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: (3/9) – HHS released an Environmental Scan on Population-Based Total Cost of Care Models in the Context of APMs and physician focused payment models (PFPMs) as part of the Physician-Focused Payment Model Technical Advisory Committee (PTAC)’s work related to the development of larger population-based models with accountability for quality and total cost of care.
Government Accountability Office (GAO): (3/7) – GAO released a report about geographic adjustments to physician payments for physicians' time, skills, and effort and found that Medicare’s payment system generally does a good job of adjusting for differences in an area’s relevant costs. Full report
Medicare Payment and Advisory Commission (MedPAC): (3/15) – MedPAC released its March 2022 Report to Congress on Medicare Payment Policy. The report evaluates Medicare payment issues and make recommendations to the Congress and includes four additional legislative mandates to report on a payment adjustment for certain low-volume acute care hospitals; on recent changes to the home health payment system; on the performance of certain specialized Medicare Advantage plans; and on a value-based payment program for post-acute care services. Report
Medicaid and CHIP Payment and Access Commission (MACPAC):(3/15) – MACPAC releases its March 2022 Report to Congress on Medicaid and CHIP, which contains three chapters of interest to Congress: (1) transitioning Medicaid beneficiaries out of institutions and back into the community under the Money Follows the Person (MFP) demonstration program, (2) improving access to vaccines and vaccination rates for adults enrolled in Medicaid, and (3) MACPAC’s statutorily required review of hospital payment policy for the nation’s safety-net hospitals. Report
Medical Economics: (3/15) – Shawn Martin, CEO of the American Academy of Family Physicians writes the value of primary care to individuals and our health care system has never enjoyed broader recognition, but it has also never been at greater risk. He argues this is primarily due to a failed financing model. To truly achieve the full benefits of primary care, he writes we must support a more comprehensive, longitudinal, multimodal, and proactive style of primary care versus the reactive, episodic, sick-focused, fee-for-service system that exists today.
Spotify: (3/9) – Dr. Mandy Cohen of Aledade joined a Second Opinion podcast with Bill Frist, former Senate Majority Leader. On the podcast, Dr. Cohen discusses a range of issues, including how whole-person care and value-based care can result and will result in better quality care, and how data leads to effective wrap-around solutions to benefit the health and wellbeing of patients.
Science Direct: (3/8) – Authors from Aledade released a study finding that primary care participation in accountable care models can contribute to preparedness for future public health crises. The authors found that rapid adaptation of ACO infrastructure assisted independent practices across the country to reach vulnerable patients with proactive guidance for staying well at home.
Commonwealth Fund: (3/15) – Commonwealth Fund released a brief that highlights gaps in the U.S. primary care system by comparing its performance to systems in 10 other high-income countries. The report found U.S. adults are the least likely to have a regular physician or place of care, or a longstanding relationship with a primary care provider.
Fierce Healthcare: (3/15) – Two organizations are working together on a joint venture called Collaborative Choice Healthcare to expand value-based care in rural Colorado. The initiative was announced earlier this month and was launched by Community Care Alliance (CCA), an accountable care organization, and Collaborative Health Systems (CHS), a population health management organization. The initiative will reach rural health practices, critical access hospitals and health systems throughout Colorado and eastern Utah.
Modern Healthcare: (3/14) – In his budget proposal, California Governor Gavin Newsom proposed an Office of Health Care Affordability, which would order the state's hospitals, doctors' offices and insurance companies to keep their costs below a certain level. At least four other states — Massachusetts, Maryland, Rhode Island and Oregon — have similar offices. But none is as comprehensive as the one proposed in California.
Modern Healthcare: (3/14) – Special purpose acquisition companies experienced a meteoric rise in 2020, when more healthcare companies turned to these "blank check" companies as an alternative to executing their own initial public offerings. SPACs, which raise money through IPOs and use it to acquire other companies and take them public, were involved in 119 deals across all sectors in the third quarter of 2020 valued at a cumulative $40 billion, according to consulting firm RSM's analysis of Bloomberg data. So far this quarter, there have been 25 SPAC-led transactions valued at $4.1 billion, down from 437 deals worth an estimated $129.6 billion in the first quarter of 2021.
Commonwealth Fund: (3/11) – Although primary care is the lifeline of a health care system, the United States spends less on it and more on specialty care than other high-income countries. On the latest episode of The Dose, host Shanoor Seervai asks Asaf Bitton, M.D., executive director of the health innovation center Ariadne Labs, what it will take to rebuild the nation’s broken primary care system.
AJMC: (3/11) – Alternative payment models (APMs) encouraging provider collaboration may help small practices overcome the participation challenges that they face in APMs. This study found that small practices in ACOs controlled costs more so than large practices. Small practice participation may generate higher savings for ACOs.
Modern Healthcare: (3/11) – A jury sided with Sutter Health in the long-running federal lawsuit accusing the health system of anticompetitive business practices that drove up healthcare costs by more than $400 million. The unanimous verdict means Sutter has successfully defended against claims that it illegally forced insurers to include all 24 of its hospitals in their contracts, a practice known as tying. The 10-member jury also found Sutter did not force health plans into contracts that prevented them from steering patients to lower-cost, non-Sutter hospitals.
Modern Healthcare: (3/10) – The percentage of medical liability insurance premiums with year-to-year increases has surged for the third year in a row, a trend that could negatively affect independent providers who have experienced relatively low rates and a soft market for roughly the past 20 years. While the proportion of medical liability premiums with annual increases was somewhat stable between 2010 and 2018, in 2019 around 27 percent of premiums saw increases—nearly twice the rate from the previous year, according to a recent analysis by the American Medical Association.
AJMC: (3/9) – This study sought to determine associations between a large-scale primary care redesign—the Comprehensive Primary Care Plus (CPC+) Initiative—and the extent of continuity or fragmentation of ambulatory care for Medicare fee-for-service beneficiaries during the first 3 years of CPC+. The study found no evidence that CPC+ increased continuity or decreased fragmentation of care.
Pubmed: (3/8) – This study sought to understand the challenges and lessons learned from implementing the Pennsylvania Rural Health Model for all-payer prospective global budget reimbursement. The study found that having a champion at the state and hospital level, significant cooperation across state agencies and between federal and state agencies, and support from nongovernment stakeholders was key to success of the model.