Why CMS’ Primary Cares Initiative Can Reshape Healthcare

With their recent announcement, the Centers for Medicare and Medicaid Services (CMS) addressed a concept we’ve long believed to be true: Primary care is foundational in driving the shift to value-based care.
Department of Health and Human Services Secretary Alex Azar hit the nail on the head when he said, “For years, policymakers have talked about building an American healthcare system that focuses on primary care, pays for value, and places the patient at the center. These new models represent the biggest step ever taken toward that vision.”
The Primary Cares Initiative is based on the strong body of evidence that shows primary care is associated with “higher quality, better outcomes, and lower costs within and across major population subgroups.” This program recognizes the tremendous power of physician-led accountable care organizations (ACOs). These groups are powerhouses — nimble, agile, and not incentivized to “feed the beast” with costly additional procedures like their counterparts, hospital-based ACOs.
However, it’s important to clear up a major misconception: physician-led doesn’t mean physician-only.
Providers need the capabilities and infrastructure to succeed, the support that enables them to freely exercise their expertise. They need backing if they’re going to do what they do best: treat patients. In other words, physicians should be able to focus on their patients instead of heavy administrative burdens.
So how can we help?
You have to start by meeting providers where they are. For most providers, that means stuck in fee-for-service arrangements where they’re rewarded for performing more services instead of delivering high-performance outcomes. Providers have long focused on quality of care, but in value-based care arrangements, they now have to pay attention to resource utilization with the goal of reducing the overall cost of care.
That’s a lot to take on at once. As overdue as this transition is, as tempting as it is to rush into risk-based contracts, you have to prioritize provider engagement and the patient experience. Success in these areas requires data on healthcare costs, tools to analyze costs related to outcomes, aligned financial incentives, and other measures that support the capabilities I mentioned above.
I’ll give one example of how these tools can help providers and patients while transitioning to value-based care.
A few months ago, our Chief Technology Officer Chris Voigt and his team used patient-reported quality data to close 12,000 care gaps identified using a customized electronic health record. This saved primary care providers the equivalent of 125 days’ worth of work.
With that recouped time, providers were able to engage and treat patients. Providers’ time and attention are investments that, over time, lower costs and lead to healthier patients. That’s why CMS’ new plan shows so much promise. This is a bold step for the future of medicine, and we couldn’t be more excited to be a part of it.