Primary Care: Its Essential Role in Value-Based Health Care NCHC - PowerPoint PPT Presentation

Primary Care: Its Essential Role in Value-Based Health Care NCHC Primary Care Forum March 1, 2017 Nitin S. Damle, MD, MS, MACP President, American College of Physicians

Medicare Payments Uncertain Prior to MACRA  Sustainable Growth Rate (SGR) formula left physicians with uncertainty in payments  Limited ability to make practice improvements to enhance quality of care for patients 2

Medicare Access & CHIP Reauthorization Act (MACRA) and its Importance to Primary Care  MACRA ushered in a much-improved payment and delivery system, especially for primary care:  Care becomes more patient-centered  Focus of care is on value and not volume  Physicians have more flexibility and control in how they get paid; two payment pathways, flexible pace  Incentivizes new models of care and delivery, including patient-centered medical home 3

PCMH Recognition in MACRA  Merit-Based Incentive Payment System (MIPS) • PCMH automatically gets full credit in one specific performance category that helps determine my payments.  Alternative Payment Models (APMs) • Comprehensive Primary Care Plus (CPC+) is a PCMH model • Potential national medical home model in future 4

Comprehensive Primary Care Plus (CPC+)  Multi-payer advanced primary care medical home model  Includes a financial risk requirement  Requires practices to have enhanced primary care functions  Additional payments for care management and performance incentives 5

Importance of CMMI (Innovation Center)  CMMI is essential to implementation of the APM pathway and to MACRA’s overall success  Explicit roles defined in MACRA law • Designs and tests new APMs • Expands successful test models for broader implementation  Preservation of these roles necessary to maintain viable APM options and innovations  Recommend additional PCMH model be expanded and implemented nationally 6

Support for Primary Care Moving Forward and How Congress Can Help  Managing chronic conditions  Ensuring adequate payment of providing chronic care management services  Support Senate Finance Committee efforts to develop comprehensive chronic care legislation  Integrating behavioral health into primary care  Tackling the opioid crisis  Ensure full implementation and funding of the Comprehensive Addiction and Recovery Act (CARA) 7

Maintaining Coverage and Access to Primary Care and How Congress Can Help  Continue implementation of MACRA  Ensure affordability of private coverage, including through subsidies or tax credits for premium and cost-sharing expenses  Maintain stable federal support for state Medicaid and CHIP programs  Continue to reduce the number of Americans without health coverage 8

Resources/Questions Questions? ACP Staff Contacts: Walt Gorski – wgorski@acponline.org Stacey Harms – sharms@acponline.org Resources: www.acponline.org/macra 9