Value Based Payment

Nov. 5-9: Azar to Discuss Primary Care Amid Expectations of New Models

November 2, 2018 9:29 am

CMS officials have recently said thatupcoming physician payment models will focus on end-stage renal disease, cancer care, chronic disease, “individuals with serious medical conditions,” primary care redesign, and services delivered in the home.

Nov. 1—Primary care will draw the attention of the Trump administration next week, amid the expectation that upcoming payment models will focus on that segment.

Alex Azar, secretary of the U.S. Department of Health and Human Service (HHS), will address the Fall Meeting of the Patient-Centered Primary Care Collaborative on Nov. 8 regarding the importance of primary care and “transformation efforts”—including the Comprehensive Primary Care Plus (CPC+) program—by the Center for Medicare & Medicaid Innovation (CMMI).

Azar’s address will follow his recent comments to the Physician-Focused Payment Model Technical Advisory Committee (PTAC), in which he urged implementation of “models that provide better care at a lower price, not just new models for the sake of new models, and not new systems of payment for old systems that aren’t open to real change.”

Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS), told PTAC that one of her “main concerns” was that only 14 percent of Medicare providers now take on financial risk.

“From my perspective, value doesn’t always mean everybody taking full risk,” Verma said. “And what we want to create is as many opportunities for providers to participate in value-based models, but understanding that not every provider is going to want to take two-sided risk.”

CMS seeks to make available “as many opportunities as possible”—and, for providers that take on more risk, to offer more waivers “from a lot of those regulatory burdens that stand in their way in creating innovative, high-quality care.”

“You’re going to see more models from us,” Verma said. “I’m concerned that we don’t have enough models, and that’s why I’m particularly very supportive of the work that PTAC has done.”

Coming Models

Verma said CMS is focusing new models on end-stage renal disease, cancer care, chronic disease, and “individuals with serious medical conditions.”

Adam Boehler deputy administrator of CMS and director of CMMI, is in charge of developing the new models. He also highlighted upcoming models in those areas, as well as “primary care redesign” and “services delivered in the home.”

“They are active, and they’re directly based on the work of PTAC,” Boehler said about models his office is creating.

At its September meeting, PTAC recommended at least partial implementation of three physician-focused models after previously urging HHS to act on 10 models.

In developing new models, Boehler sought to identify elements that proved successful in the past: transparency (i.e., being open about sharing data), simplicity, and accountability.

“The best way to create models that people can depend on and drive care is to simplify them as much as possible,” Boehler said.

Additionally, the new models will aim to “empower our model participants to succeed, but then we also need to hold them accountable for that,” he said.

Ideas for the new models were generated from CMS staff and “other stakeholders,” in addition to PTAC, he said.

“We’re pretty myopic in our focus,” Boehler said about the coming models. “It’s what is going to improve quality outcomes, lower cost, and drive choice for the American patient.”

The first model that CMMI introduced under his leadership began earlier this year and is called Integrated Care for Kids. It focuses on the opioid crisis.

“There will be multiple others announced soon,” Boehler said in a September address at PTAC.

Model Approaches

Some upcoming models also will involve mandatory participation “and other mandatory reforms,” Azar said.

“Requiring participation can be necessary to determine whether a model really works, but it may also be necessary to meet what we see as an urgent need for reform,” Azar said.

But the models also were expected to be less prescriptive in their execution.

“We are not going to be overzealous in determining how these reforms happen,” Azar said. “We’re interested in driving the outcome we want, rather than micromanaging how you get there.”

Azar cited the example of rehabilitation hospitals, at which CMS requires a specific ratio of patients to nurses or physicians, as the type of requirement that will not apply to the new models.

“Now, oversight of healthcare facilities is a responsibility we take incredibly seriously at HHS,” Azar said. “But if you talk to any patient about what they want from health care, it’s not process, it’s outcomes.”

Thus he is pressing CMS to “move away from this idea of micromanaging through regulation, and just paying to make sure patients get healthy again.”

Monday, Nov. 5

Comments due on a coming report from Office of the Surgeon General and the Centers for Disease Control and Prevention on needed private-sector investments to improve health. Learn more.

Tuesday, Nov. 6

Election Day.

Webinar by HFMA titled “Investing in a Self-Service Patient Financial Experience.” Learn more.

Briefing by Health Affairs on “Patient Safety,” Washington, D.C. Learn more.

Webinar by CMS titled “Meeting the Needs of Dually Eligible Older Adults with Schizophrenia.” Learn more.

Online seminar by MGMA on “Payer Contracting.” Learn more.

Wednesday, Nov. 7

Workshop by the American Hospital Association titled “Leading Together: The New Paradigm for Healthcare,” Charlotte, N.C. (through Nov. 8). Learn more.

Webinar by America’s Health Insurance Plans (AHIP) titled “Applying analytics to opioid crisis: prescription for success.” Learn more.

Webinar by the Agency for Healthcare Research and Quality titled “The AHRQ Safety Program for Improving Antibiotic Use: A National Program for Antibiotic Stewardship.” Learn more.

Webinar titled “Opioid Crisis: What one health plan is doing about it.” Learn more.

Meeting by AJMC’s Institute for Value-Based Medicine titled “Advancing Quality in Oncology Care,” Seattle. Learn more.

Webinar by the National Business Group on Health titled “Award Winning Success Stories on Identifying Social Determinants of Health and their Approaches to Advance Health Equity.” Learn more.

Thursday, Nov. 8

Web conference by the Advisory Board titled “State of the Union 2018.” Learn more.

Webinar by AHIP titled “How Innovative Engagement Strategies Close Care Gaps.” Learn more.

Friday, Nov. 9

Livestream of a Harvard School of Medicine event titled “Universal Healthcare: An Idea Whose Time Has Come?” Learn more.


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