The monumental shift in health care from fee-for-service or a volume-based approach to value-based care will change health care delivery for the better in the United States. When physicians do what is necessary and avoid over-testing and procedures of limited or no value, the outcomes are best for the patient, and for the entire health care system.
The Centers for Medicare and Medicaid Services have tested and continue to test models in the delivery of value-based care. I was a practicing physician (internist and nephrologist) for 25 years before I founded the nation’s leading concierge medicine company. One of my core beliefs was that if I had more time with each one of my patients, I could have a large impact on reducing acute hospitalizations, making accurate diagnoses, and better control and coordinate care of chronic conditions to avoid acute episodes. This turned out to be true, and the company I founded now has about more than 300,000 patients and about 900 participating physicians. I’m biased, but I believe that it has had a significant impact on reducing federal and private insurance health care spending in the U.S. About 50 percent of my own patients were Medicare age. If this ratio is applied to all our physicians, this focus on the doctor-patient relationship has played a part in reducing Medicare costs.
CMS is launching a new initiative called Primary Care First. Primary Care First emphasizes the doctor-patient relationship (i.e., more time with each patient), and as CMS states, “the model aims to improve the experience for beneficiaries by reducing administrative burdens so practitioners can spend more time with the patient.” Doctors will be paid both a flat visit fee, as well as a monthly population-based fee based on the average risk score of the patients. Physicians are able to share in the savings (up to a 50 percent bonus), and must also take on a small amount of risk (10 percent). The single outcome metric of Primary Care First in year 1 is to reduce acute hospital utilization, and starting in year 2, CMS will also measure outcomes of Primary Care First by looking at controlling hemoglobin A1c, controlling high blood pressure, providing colorectal screening, etc. The outcomes measured by Primary Care First are essentially the same as the outcomes that we focused on. I believe that Primary Care First is an exceptionally positive development for value-based care for the traditional Medicare population.
Finally, doctors who remain in traditional Medicare are going to be paid the right way: a model that rewards phone calls, emails, and patient care coordination, with a small fee as well for the extra time burden of office visits.
Primary Care First is a promising initiative at the Centers for Medicare and Medicaid Services, and I am confident that it will have a positive impact on health care delivery.
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