Primary care provider consults patient.

How Can States Follow Maryland’s Lead to Empower Primary Care Physicians?

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Maryland is a consistent trailblazer in healthcare. As part of the state’s all-payer model, the innovative Maryland Primary Care Program (MDPCP) has demonstrated how investing in primary care through a regionalized model can reduce waste in the healthcare system, advance value-based care, and improve patient health outcomes.

What Is MDPCP?

According to Sam Starbuck, Vice President of Privia Quality Network — Mid-Atlantic, the launch of MDPCP illustrated a commitment to “improving patient care and reigning in unnecessary medical costs across the state” while financially rewarding primary care physicians for “for their part in making these goals a reality.” In short, MDPCP is a state-specific value-based care model.

MDPCP, which is voluntary and open to all qualifying physicians, “provides funding and support for the delivery of advanced primary care throughout the state,” per the Maryland Department of Health. Qualified and participating physicians work to improve health outcomes for Medicare beneficiaries while managing overutilized services and high-cost care settings to reduce total costs of care. To qualify, physicians must meet the five Comprehensive Primary Care Functions of Advanced Primary Care, which include:

  • Access and Continuity – Patient-to-provider assignments, dedicated care teams, appropriate access to care, and 24/7 access to care
  • Care Management – Longitudinal and episodic care management, risk stratification, goal-directed care plans, and integrated behavioral health
  • Comprehensive Care and Coordination – Care transitions, practice transformation, referral management, and social needs assessments
  • Patient and Caregiver Experience – Patient and family advisory council (PFAC), patient satisfaction surveys, and patient engagement
  • Planned Care for Health Outcomes – Preventive care, addressing gaps in care, health IT, use of data to make informed decisions on patient needs, as well as quality, utilization, and performance reporting

Based on their capabilities in these five areas, physicians enter into one of two tracks that differ in terms of levels of risk, payments, and expectations. For assistance, physicians work with Care Transformation Organizations (CTOs). These CTOs offer management services related to care coordination, care transitions, standardized beneficiary screening, data tools and informatics, and practice transformation assistance, according to Gordon Feinblatt, LLC.

How COVID-19 Demonstrated the Value of MDPCP

By 2020, the nearly 500 MDPCP practices were “serving more than half of Maryland’s population,” according to the JAMA Health Forum. The practices received “visit-independent payments to facilitate addressing the physical, behavioral, and social aspects of their patients’ health” as well as “guidance, technical support, and coaching support.”

These payments supported practices as patient volume and, consequently, revenue decreased. Additionally, the emphasis on care coordination and continuity facilitated COVID-19 testing, securing personal protective equipment (PPE), and webinars to combat misinformation and share best practices and safety guidelines. MDPCP-affiliated practices also accessed risk stratification and analytic tools to target vulnerable patients. Furthermore, according to JAMA Health Forum, 99.2 percent of MDPCP practices had employed telehealth for patients, which was instrumental in caring for patients remotely.

As researchers with JAMA concluded: “The role that the MDPCP has been playing during the pandemic offers an illustration of the value of integrating primary care and public health. With support and guidance from MDH Public Health, the program’s primary care practices have successfully advanced community health in Maryland during the COVID-19 pandemic and may serve as a blueprint for other states to follow.”

That evidence raises the question: What can other states glean from MDPCP’s successes to incorporate into their own models?

The Immense — and Overlooked — Value of Primary Care

Primary care has repeatedly demonstrated its ability to improve patient health and reduce costs. Despite data that indicates spending more on primary care may reduce hospitalization costs, the industry is actually decreasing investments in primary care.

MDPCP, however, reverses this trend. The “risk-stratified per-beneficiary per-month Care Management Fee as well as an at-risk Performance Based Incentive Payment” provide participating practices with “compensation for their efforts to coordinate care and reduce potentially avoidable care,” as noted by Miles & Stockbridge.

Not only do these payments reward doctors for delivering high-quality care, but also enable physicians to invest in tools, technology, and resources that engage patients and advance value-based care. The CTOs — such as accountable care organizations (ACOs) and clinically integrated networks (CINs) — further enhance clinical care with care managers, assistance for social determinants of health, and additional support.

The Importance of Regionalized Care

Population health is a foundational aspect of both MDPCP and the “Quadruple Aim.” The Quadruple Aim framework seeks to improve provider well-being, advance population health, enhance the patient experience, and reduce per capita healthcare costs. Patient populations’ needs vary widely county by county, and especially state by state. Acknowledging and respecting this market specificity is crucial to success in value-based care, yet too often organizations ignore this point. A lack of regionalized care is perhaps one of the main reasons why Haven, the once-promising healthcare joint venture, didn’t succeed.

This region-specific program design is also the impetus for the Centers for Medicare and Medicaid Services’ (CMS’) recent Geographic Contracting Model. Data supports the adage, “A ZIP code affects a patient’s health almost as much as their genetic code.” Tailoring care delivery to improve the health outcomes of a unique region’s patients is crucial. To respect this regional perspective, care teams should employ methods to lower the total cost of care or utilize community resources. MDPCP offers the tools to do so on a micro-level. Since MDPCP defines quality as both clinical measures and patient satisfaction, the model encourages a greater appreciation for local health needs.

As COVID-19 has proven, MDPCP has delivered on its goal of transforming the healthcare process by allowing “primary care providers to play an increased role in prevention, management of chronic disease, and preventing unnecessary hospital utilization.” As Ann Greiner, President and CEO of the Primary Care Collaborative, told MedPage Today: “Higher-spending states on primary care have fewer avoidable hospitalizations, fewer [emergency department] visits, and fewer overall hospitalizations, so if you spend upstream, you reduce those more expensive and problematic outcomes downstream.”

However, to succeed in such programs, care teams require robust support, such as patient-to-physician empanelment, risk stratification, referral management, patient engagement tactics, and more. Other states can start to capitalize on the Program’s demonstrated success by prioritizing primary care and implementing region-specific care delivery.

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