If we want better health care at a lower cost, primary care must become a policy priority

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Early last year, dozens of leading health organizations, including the National Coalition on Health Care (NCHC), called on the Trump administration to push forward on value-based reforms in the Medicare payment system.

We believe that “putting our foot on the gas” to accelerate the shift to a system where incentives are aligned for better delivery and provider payment is essential to a more affordable health system for all of us.

{mosads}We were pleased to see Secretary of Health and Human Services Alex Azar clearly signaled his intention to emphasize a continued focus on value in recent speeches. The recent Request for Information (RFI) from the Centers for Medicare and Medicaid Innovation (CMMI) focused on direct provider contracting also reinforced that this administration will build upon ongoing work to move away from fee-for-service (FFS) payment models that reward quantity of tests, procedures and visits over quality of care and outcomes.


In particular, the RFI reinforces some very important themes that align with NCHC’s recommendations as we continue the march to value and look to the next phase of new payment models.

First, CMMI acknowledges the importance of adopting models that have proven successful in the private sector and in Medicare Advantage. We support more advanced models in traditional Medicare that align with the private sector’s most aggressive efforts at reform, such as capitated and global payment. Giving providers options to take on more financial risk over time will facilitate more success under MACRA, the landmark 2015 physician payment law.

Importantly, global payment models enable more flexible-care-delivery models so providers are not crippled by FFS billing, but rather, can offer services, care and technology that better meets the needs of chronically ill patients. Those services could include transportation, home visits, telehealth, social services and behavioral care, all of which are increasingly important to meet the needs of Medicare beneficiaries, but not typically covered under FFS Medicare.

The RFI also acknowledges the importance of primary care. Successful employers, plans, and health systems are finding strong primary care to be absolutely essential. Yet nationally, the United States spends only 4 to 8 percent of health care dollars on primary care, compared to an average of approximately 12 percent among other industrialized countries — each of which spends substantially less on health care than the United States.

To build an American health-care system that delivers better care at a lower cost, primary care must become a national health policy priority. Moving toward population based payments and financial risk provides a strong incentive for clinicians to resource front end, primary and holistic care that has been shown to successfully offset unnecessary hospital readmissions, emergency room visits and other preventable health-care costs.

Medicare was established to provide seniors and disabled Americans with both health and financial security. An aggressive approach to driving affordability and quality has to be paired with strong beneficiary protections. Those include preserving beneficiaries’ freedom to seek care from outside the practice, maintaining protections against balance billing practices, and establishing strong guidelines so providers in at-risk and capitated models build the capacity to provide more holistic care to patients rather than restricting care. In Medicare, such protections go hand-in-hand with an aggressive move to value-based care; and in fact they are central to its success.

We commend and support the early signals coming from this administration on its approach to value. Improving our health-care system to meet the needs of today’s consumers is a national priority and one that will require input from a broad range of health-care stakeholders. The National Coalition stands ready to help move the value agenda forward.

John Rother is the president and CEO of the National Coalition on Health Care and was the AARP’s executive vice president of policy, strategy, and international affairs.

Tags Health Health care Medicare Primary care

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