Monday, August 1, 2016

The Return of the HMO?

In a recent new piece in Modern Healthcare they state:

The CMS will launch an ambitious primary care quality improvement initiative in four regions and 10 states that include Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee.  The markets for the Comprehensive Primary Care Plus (CPC+) initiative were selected based on density and interest shown by practices and payers. Fifty-seven not-yet-named payers will participate. The regions include Kansas City, the North Hudson valley in New York, Philadelphia and Northern Kentucky. Under CPC+, the CMS and other insurers would pay physicians a monthly fee for patient primary-care visits. The new model aims to improve health outcomes and lower cost not only for Medicare beneficiaries, but also consumers enrolled in commercial plans and other coverage options such as insurer-managed Medicaid plans.

 This appears to be a revamping of the HMO model of the 90s. We knew how that played out. But now it is for Medicare where the patients have no second exit.

As CMS states:

The Centers for Medicare & Medicaid Services (CMS) today announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care....Building on the Comprehensive Primary Care initiative launched in late 2012, the five-year CPC+ model will benefit patients by helping primary care practices:

  • Support patients with serious or chronic diseases to achieve their health goals
  • Give patients 24-hour access to care and health information
  • Deliver preventive care
  • Engage patients and their families in their own care
  • Work together with hospitals and other clinicians, including specialists, to provide better coordinated care
Primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions and meet the criteria listed above, but practices in Track 2 will also provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of their psychosocial needs and an inventory of resources and supports to meet those needs.

This may dramatically curtail any Medicare services and it considered a dramatic means to ration care by putting the burden on the primary care physician.

As of today CMS notes:

Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation. CPC+ will include two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States (U.S.). The care delivery redesign ensures practices in each track have the infrastructure to deliver better care to result in a healthier patient population. The multi-payer payment redesign will give practices greater financial resources and flexibility to make appropriate investments to improve the quality and efficiency of care, and reduce unnecessary health care utilization. CPC+ will provide practices with a robust learning system, as well as actionable patient-level cost and utilization data feedback, to guide their decision making.