They are the stories that make us cringe, because their human and financial costs are as massive as they are avoidable. A middle-aged woman newly diagnosed with diabetes knows she has to test her blood sugar levels but doesn’t know how to manage her diet. A patient goes home from the hospital without clear instructions about medications or help accessing the home-based follow-up care he needs, and ends up in the emergency room and then readmitted to the hospital. A doctor without the information that his patient has early-stage dementia prescribes a medication that induces delirium, which worsens her dementia for months.
As consumer and physician health leaders, we hear stories like these every single day. Without question, we recognize the role they play in causing health costs to skyrocket, frustrating practitioners, and harming patients and families. Yet for years, nothing has changed. The United States invests hundreds of billions of dollars in high-tech equipment and ever-more-complex procedures, while failing to give primary care practices the resources they need to coordinate care among a patient’s various clinicians, help patients avoid unnecessary hospitalizations, or enable them to manage their conditions and get essential preventive care.
How we pay for patients’ care is a major factor in the care we get. For example, we pay primary care clinicians in this country dramatically less than their counterparts in specialty fields. And our reliance on fee-for-service payments rewards the volume of services delivered and ignores the critical tasks of coordinating care.
It’s no wonder that the cost of health care in America has spun out of control.
But at long last, some of that may be about to change. There is hope on the horizon. The initiative to prioritize primary care by the Center for Medicare and Medicaid Innovation within the U.S. Department of Health and Human Services is one of the most significant and promising initiatives to come out of health reform to date. We all have a lot at stake in its success.
Starting in seven communities across the country, we learned recently, the Comprehensive Primary Care Initiative will increase payments from Medicare and 45 private insurers to primary care physicians and practices that: provide higher quality, easily accessible care; engage patients and caregivers as they transform their practices; emphasize prevention and management of chronic and complex conditions; assure better communication across practitioners and effective use of health information technology; and ensure smooth transitions of care for their patients across settings such as hospital to home. This approach to improving care has strong support from patient and consumer advocates as well as private employers in each of these communities. This kind of across-the-board support is vital to the success of these efforts
Through this Initiative, Medicare and other public and private insurers will pay primary care practices more for providing patient-centered, better coordinated care. More than 330,000 Medicare beneficiaries initially are expected to benefit from this new program, joined by hundreds of thousands of patients enrolled in private insurance and Medicaid. That’s right—instead of paying physicians mainly on how many procedures they do, participating practices will be paid more for achieving better results for their patients. The amount of the increase will be determined by how sick their patients are so that practitioners have the resources they need to effectively treat the oldest, sickest and most complex patients. Over time, as better primary care results in healthier patients, doctors will share in the savings that result from smarter use of health care resources. That’s a win for everybody, and an approach that’s long overdue.
We are especially pleased that this Initiative will promote patient engagement and use feedback from patients and family caregivers to help assess how effectively primary care practices are transforming themselves. That will give patients and caregivers a voice and encourage real partnership between patients and their providers. It is a smart, enormously promising approach.
There are times when consumers, clinicians, and payers are on opposing sides as policies are being shaped. This isn’t one of those times. This is an initiative that we all can support because it will give doctors the resources they need to coordinate care for their sickest patients, give patients a voice as practices are transformed, and give us all better value for our health dollars, which will help patients, clinicians, payers, employers, our government and our economy.
So much of the debate over reforming our health system has been loud and contentious. And then an initiative like this comes along, which has the potential to truly transform care in fundamental and badly needed ways – and it makes barely a ripple. But don’t be fooled. The promise and potential impact of the Comprehensive Primary Care Initiative is enormous.
The Center for Medicare and Medicaid Innovation got this one right. The new Comprehensive Primary Care Initiative points the way to better care, healthier communities and better value for our health care dollars. Now, doctors, patients, and both public and private payers have to come together to make it work. We are ready.