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

Primary Care: Its Essential Role in Value-Based Health Care

Nitin S. Damle, MD, MS, MACP President, American College of Physicians

NCHC Primary Care Forum March 1, 2017

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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

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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

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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

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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

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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

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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)

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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

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Resources/Questions Questions?

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