New Medicare Models Can Advance the System-Wide Transformation Required for Value-Based Health Care

Following recent announcements from the Health and Human Services (HHS) department on new accountable care initiatives for primary care physicians, health care executives presented a prescription for the growth of value-based care at the 2019 World Health Care Congress.

The proposed new models are very important because they create additional pathways for primary care physicians to participate in accountable care and population health, said panel moderator Norman Chenven, M.D., founding CEO, Austin Regional Clinic; and Vice Chairman, Council of Accountable Physician Practices (CAPP), a coalition of visionary medical groups and health systems leaders. To transform our health care system to deliver better, more efficient care, we must change to a true value-based system “ not only in payment, but in scalable clinical and operational methods as well. All players must be aligned in this seismic shift “ including hospitals, primary care, and specialists.

The Centers for Medicare and Medicaid Services (CMS) Primary Cares Initiative is described by HHS as a new set of payment models that will further empower primary care to deliver better value for patients throughout the healthcare system. CMS projects the new voluntary programs will shift at least a quarter of people in traditional Medicare out of fee-for-service. The focus is on smaller physician practices as well as larger groups, giving options for participation and bonuses for patients who are kept healthy and out of the hospital.

The World Health Care Congress panel, Do Medicare Changes Enhance or Hinder Clinical and Payment Transformation?, also sparked discussions of the magnitude of change required to go from a 100-year-old fee-for-service approach that focuses on sick people to a paradigm that rewards the ability to keep people healthy and to manage them efficiently if they are ill. The role of the primary care doctor is critical to this shift because the patient-doctor relationship fosters wellness and prevention.

Panelists included Valinda Rutledge, Vice President of Federal Affairs, Americas Physician Groups and Vice President, Public Payer Health Strategy, Greenville Health System; Niyum Gandhi, Executive Vice President and Chief Population Health Officer, Mount Sinai Health System; Melanie Matthews, Chief Executive Officer, Physicians of Southwest Washington; and Paul Grundy, MD, Founding President, Patient-Centered Primary Care Collaboration.

About the Council of Accountable Physician Practices

The Council of Accountable Physician Practices (CAPP), an affiliate of the AMGA Foundation, is a coalition of visionary medical group and health system leaders. We believe that physicians working together, backed by integrated services, systems and data and technology, can best shape and guide the way care is delivered so that the welfare of the patient is always the primary focus. For more information, contact CAPP at http://accountablecaredoctors.org/.

Joy Scott, CEO, Scott Public Relations
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