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HHS Secretary Azar Announces CMS Primary Cares – A Historic Turning Point In American Healthcare

Secretary of Health and Human Services Alex M. Azar CMS Primary Cares Press Conference

April 22, 2019  |  CMS.gov

This is the speech (as prepared) delivered by HHS Secretary Alex M. Azar, April 22, 2019 in Washington, D.C.

Good afternoon, everyone, and thank you so much for joining us. Thank you in particular to the American Medical Association for inviting us here to announce today’s news.

It’s appropriate to be at the headquarters of an organization with such a long history in American medicine, because I believe we’ll look back at what we’re announcing today as a historic turning point in American healthcare.

Today’s announcement is the culmination of years of work by many at HHS and throughout American healthcare.

When I announced last year that moving toward a value-based healthcare system would be one of my priorities as secretary, I was well aware that I was at least the fourth HHS Secretary to take this issue seriously, dating back through Secretaries Burwell and Sebelius to Secretary Leavitt, who first laid out the idea of paying for value rather than procedures.

It is only thanks to the efforts of my predecessors that we get to take this major step forward. Today also could not be possible without the enthusiastic engagement of so many physicians and other providers. That includes members of HHS’s advisory committee on physician-focused payment models, PTAC—a member of which we have here today, Kavita Patel.

That committee has analyzed a huge number of payment model ideas from physicians who are excited about innovation. Their work, including submissions from the American Academy of Family Physicians, the American Academy of Hospice and Palliative Medicine, and the Coalition to Transform Advanced Care, has inspired many significant aspects of the initiative we’re announcing today.

So what are we announcing? We’re launching CMS Primary Cares—an initiative with two sets of new payment models that will enroll a quarter or more of traditional Medicare beneficiaries and a quarter of providers in arrangements that pay for keeping patients healthy, rather than ordering procedures.

The Primary Care First path will allow smaller primary care practices to be paid a simple, flat stream of revenue for each patient. When a patient stays healthy and out of the hospital, these practices will get paid a bonus. But if the patient ends up sicker than expected, these practices will bear responsibility for the extra spending, up to a certain share of their practices’ revenue.

The other path, Direct Contracting, is more ambitious and aimed at larger practices. Just like in Primary Care First, when patients have a better experience and stay healthier, these practices will make more money. But if patients end up sicker, Direct Contracting practices will bear the risk for the extra health spending, not just at their own practice but throughout the system.

Providers will have greater flexibility to spend these resources how they want, allowing them to come up with innovative ways to care for patients—and receive significant savings if they keep patients healthier than expected.

Within this initiative, we will also have options for providers who want to focus on particular populations and particular serious illnesses—where there is huge potential for better health outcomes and more savings.

We’re also seeking input on another Direct Contracting model, to award a local entity a contract for an entire geographic area, covering all patients and providers in the area who want to opt into this arrangement.

This would provide an unprecedented ability for that local organization to negotiate better rates than Medicare does today, take responsibility for outcomes, and provide benefits that work for the local community’s needs.

Primary care is a small slice of health spending overall, but it has a significant impact on downstream costs and quality.

This initiative will radically elevate the importance of primary care in American medicine, move toward a system where providers are paid for outcomes rather than procedures, and free doctors to focus on the patients in front of them, rather than the paperwork we send them.

In just a minute, I’ll turn things over to Administrator Verma—I’m sorry to say, she is the one who sends doctors the paperwork, but she’s made sure there’s less and less of it every year.

Then we’ll hear from my senior advisor for value-based transformation and CMMI’s director, Adam Boehler. They’ll both discuss more details about this initiative and the range of options it’s going to offer for patients and clinicians.

Moving in this direction, toward value-based care, has been largely just a vision for so long. Now, value-based care is a reality, for a quarter of traditional Medicare beneficiaries in primary care, and a significant and growing number of patients in other settings as well.

This is the pivotal, hockey stick moment in paying for value in American healthcare.

This initiative will lay the groundwork not just for better care and lower costs in the $700 billion Medicare program and the $580 billion Medicaid program, but will also help drive innovation toward a new, patient-centered approach in our entire $3.5 trillion healthcare system. This initiative is specifically designed to encourage state Medicaid programs and commercial payers to adopt similar approaches.

I believe that true transformation is possible because of the experiences we’ve gained, but also the bold leadership we have today. Read the full speech

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CMS to launch new direct-contracting pay models in 2020

Secretary Alex Azar

April 23, 2019  |  Susannah Luthi  |  Modern Healthcare

HHS on Monday launched an ambitious, double-pronged strategy to shift primary care from fee-for-service payments to a global fee model where clinicians and hospitals could assume varying amounts of risk.

HHS Secretary Alex Azar told a crowd of stakeholders at the American Medical Association in Washington that the CMS projects the new voluntary programs will shift at least a quarter of people in traditional Medicare out of fee-for-service.

The first model aims at small primary-care practices, offering two options with a flat monthly fee per patient. Bonuses or penalties will depend on their ability to keep their patients “healthy and at home,” said Adam Boehler, director of the CMS’ Center for Medicare and Medicaid Innovation, or CMMI.

Larger practices and health systems would have additional choices, which could be very lucrative but pose steeper risks. Under the first “professional option,” providers would assume 50% of the risk, including savings and losses. Under the “global option,” providers would take on full risk.

There is also a “geographic option,” in which health systems or insurance plans could assume the risk for the total cost of primary care for a swath of communities within a particular region.

Most of the newly announced Innovation Center models will launch in January 2020. The geographic option is projected to begin in mid-2020.

The administration officials painted the models as a sweeping overhaul of the fee-for-service model, even though the model is voluntary. Verma said the CMS hopes to incorporate state Medicaid programs as the policy rolls out across the country. Read the full article

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HHS To Deliver Value-Based Transformation in Primary Care

Doctor providing primary care in the home to a chronically ill patient

  |  cms.gov

The CMS Primary Cares Initiative to Empower Patients and Providers to Drive Better Value and Results

Today, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma are announcing the CMS Primary Cares Initiative, a new set of payment models that will transform primary care to deliver better value for patients throughout the healthcare system. Building on the lessons learned from and experiences of the previous models, the CMS Primary Cares Initiative will reduce administrative burdens and empower primary care providers to spend more time caring for patients while reducing overall health care costs. The models were developed by the Innovation Center under the leadership of Adam Boehler and are part of Secretary Azar’s value-based transformation initiative.

“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,” said HHS Secretary Alex Azar. “Building on the experience of previous models and ideas of past administrations, these models will test out paying for health and outcomes rather than procedures on a much larger scale than ever before. These models can serve as an inflection point for value-based transformation of our healthcare system, and American patients and providers will be the first ones to benefit.”

Empirical evidence shows that strengthening primary care is associated with higher quality, better outcomes, and lower costs within and across major population subgroups. Despite this evidence, primary care spending accounts for a small portion of total cost of care, and is even lower for patients with complex, chronic conditions. Primary care clinicians serve on the front lines of the healthcare delivery system, furnishing services across a wide range of specialties, from family medicine to behavioral health to gerontology. For many patients, the primary care clinician is the first point of contact with the healthcare delivery system. CMS’s experience with innovative models, programs and demonstrations to date have shown that when incentives for primary care clinicians are aligned to reward the provision of high value care, the quality and cost effectiveness of patient care improves.

“As we seek to unleash innovation in our health care system, we recognize that the road to value must have as many lanes as possible,” said CMS Administrator Seema Verma. “Our Primary Cares Initiative is designed to give clinicians different options that advance our goal to deliver better care at a lower cost while allowing clinicians to focus on what they do best: treating patients.”

Administered through the CMS Innovation Center, the CMS Primary Cares Initiative will provide primary care practices and other providers with five new payment model options under two paths:

Primary Care First and Direct Contracting

The five payment model options are:

  1. Primary Care First (PCF)
  2. Primary Care First – High Need Populations
  3. Direct Contracting – Global
  4. Direct Contracting – Professional
  5. Direct Contracting – Geographic

The Primary Care First (PCF) payment model options will test whether financial risk and performance based payments that reward primary care practitioners and other clinicians for easily understood, actionable outcomes will reduce total Medicare expenditures, preserve or enhance quality of care, and improve patient health outcomes. PCF will provide payment to practices through a simplified total monthly payment that allows clinicians to focus on caring for patients rather than their revenue cycle. PCF also includes a payment model option that provides higher payments to practices that specialize in care for high need patients, including those with complex, chronic needs and seriously ill populations (SIP).

Both models under PCF incentivize providers to reduce hospital utilization and total cost of care by potentially significantly rewarding them through performance-based payment adjustments based on their performance.  These models seek to improve quality of care, specifically patients’ experiences of care and key outcome-based clinical quality measures, which may include controlling high blood pressure, managing diabetes mellitus, and screening for colorectal cancer. PCF will be tested for five years and is scheduled to begin in January 2020. A second application round is also planned for participants starting in January 2021.  Read the full press release

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Visit HCCI at AGS19

AGS19 HCCI Booth invite

If you’re planning to attend the American Geriatrics Society 2019 Annual Scientific Meeting, May 2-4 in Portland, Oregon, make plans to stop by the Home Centered Care Institute (HCCI) exhibit booth #317.  Staff from HCCI will be on hand to answer your questions about home-based primary care (house calls) and why the future of health care is in the home.

We’ll have information about HCCI’s upcoming workshops, elearning modules, and consulting services.

If your existing HBPC practice is experiencing challenges, HCCI can help with a practice assessment, chart audits or onsite coaching.  If you’re interested in starting a house call practice, adding house calls to your existing office-based practice, or just learning about the growing field of house call medicine, HCCI offers an array of education and consulting services to help you attain your goals. https://hcci.stoutlogic.io/

Learn more about AGS19 at https://meeting.americangeriatrics.org/

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Join the Second Age-Friendly Health Systems Action Community

AFHS Action Community Invitation

Health systems are invited to join the second Age-Friendly Health Systems Action Community. This free, seven-month learning community run by the Institute for Healthcare Improvement begins on April 1st. It succeeds the first Action Community of teams from more than 75 systems working together to rapidly test and scale the Age-Friendly Health Systems 4Ms Framework. For more information, download this invitation.

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the​ Catholic Health Association of the United States.

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The Exam Table Of The Future Has Throw Pillows

C-TAC HCCI Gold SponsorPlease join HCCI on Wednesday, October 10th at the C-TAC National Summit on Advanced Illness Care where we present a breakout session on home-based primary care titled “The Exam Table Of The Future Has Throw Pillows”.

Wednesday, October 10 (1:30 – 2:30pm)
Denver Hilton City Center
Denver, CO

Home-Based Primary Care (HBPC) is hard, and it is a model of care that requires a wide array of skills, not all of them clinical. The challenging nature of the model necessitates a methodical, disciplined approach. But why does it matter? Learn why HBPC is a model whose time has come again and how HBPC programs can be built or improved in a strategic, systematic manner.

The session will be presented by;

  • Thomas Cornwell, MD, CEO, Home Centered Care Institute (HCCI)
  • Tracy Hulett, VP, External Affairs, Home Centered Care Institute (HCCI)
  • Eric de Jonge, Executive Director, MedStar House Call Program
  • Kelly Fischer, COO, JourneyCare
  • Jessica Bylander, Senior Editor, Health Affairs (moderator)

Register now: https://www.ctacsummit.org/

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AAHCM Annual Meeting and Preconference

AAHCM Annual Meeting and Preconference

Brent Feorene, Executive Director of the American Academy of Home Care Medicine stopped by the HCCI offices this week and shared what attendees could expect at the upcoming AAHCM Annual Meeting and Preconference taking place on October 25-26-27 in Rosemont, IL.


Thursday, October 25
Loews Chicago O’Hare
Rosemont, IL

AAHCM Preconference presented by Home Centered Care Institute
“Care of the Complex Patient In The Home: Staying Ahead of the Curve”

Clinical Session
9:00 am – 12:00 pm

Faculty
Elizabeth McCormick MD (Session Lead)
Julie Glendenning MS APN-BC CHPN WCC
Traci Kalpac MSW LISW-S
Linnea Nagel PA-C MPAS

Practice Management Session
1:00 pm – 4:00 pm

Faculty
Shawna Ramey CPC CPMA (Session Lead)
Bethany Skillen BSN BS RN
Amanda Tufano MHA CMPE CPPM

________________________________________________________________________________________________________________

October 26-27
Loews Chicago O’Hare
Rosemont, IL

AAHCM Annual Meeting
Driving the Change to Value-Based Care: Connecting Leadership, Quality and Ethics
The AAHCM Annual Meeting will be an independent standalone conference for the second year, building on our previous success of providing leading edge clinical and practice administration content.

Focused on the issues and challenges that face the broad spectrum of healthcare professionals providing in-home primary care, you will learn from innovators in the field about the latest advancements in delivering and managing home care medicine. Sessions will cover topics including; technology, care management, new payment models, and updates on policy.

________________________________________________________________________________________________________________

Friday, October 26
Keynote Speaker
Patrick Conway, M.D.

President, CEO 
Blue Cross and Blue Shield of North Carolina

Former Deputy Administrator for Innovation and Quality
Centers for Medicare & Medicaid Services (CMS)

Former Director of the Center for Medicare and Medicaid Innovation (CMMI)

________________________________________________________________________________________________________________

Saturday, October 27
Keynote Speaker
Cheryl Phillips, M.D.

President, CEO 
SNP Alliance

Former Sr. Vice President for Public Policy and Health Services
LeadingAge

________________________________________________________________________________________________________________

Register
To learn more or to register for the AAHCM Annual Meeting and Preconference, visit https://www.aahcm.org/page/2018_Annual_Meeting

 

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HCCI Fast Track Now Boarding

The new HCCI “Fast Track” Essential Elements of Home-Based Primary Care training is designed for physicians, APPs, and practice managers interested in the field of HBPC. “Fast Track” takes the content of HCCI’s Essential Elements 2-day workshop and presents it at a quicker pace, condensing the training into a 1-day course. Developed and taught by HBPC industry experts, “Fast Track” covers medical, social and economic issues related to providing medical care to patients in their home.

Objectives: Upon completion of the classroom workshop, learners will be able to…

  • Assess perceptions of HBPC and dispel myths about the field
  • Describe the role of HBPC in various contexts, including Public Health and the developing systems of health care, and examine key considerations, e.g., program/practice configurations, structure, administration, staffing, clinical care models, patient eligibility and market demographics, and financial/value factors
  • Apply the American Geriatric Society’s (AGS) Guiding Principles in the approach to the care of people with multi-morbidities in the home setting
  • Review the components of an HBPC assessment and discuss approaches for developing care plans that accommodate team input/access
  • Assess various options for diagnostic and operations technology to improve patient care, efficiency, and staff safety in HBPC
  • Implement recommended policies and procedures aimed at ensuring the personal safety of HBPC team members
  • Define and discuss culture, shared decision making, and biases, and describe their impact on HBPC
  • Implement self-care practices to provide patients with high-quality, compassionate health care, while also avoiding burnout and career dissatisfaction
  • Provide optimal patient care in a simulated home setting, and demonstrate appropriate coding and documentation for the visit
  • Examine and discuss the business models, economic drivers, and quality indicators for HBPC and their impact on care delivery

“Fast Track” is being offered December 6th, 2018 in Philadelphia, PA. Come aboard!

For more information on HCCI “Fast Track” Essential Elements of Home-Based Primary Care, visit http://bit.ly/HCCI_University

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Discover Why The Future of Healthcare Is In The Home

HCCI is preparing to hit the road for fall conference season. Plan to attend and learn more about the Home Centered Care Institute (HCCI) and home-based primary care (HBPC) at these upcoming conferences.

Sept 19-22 – National Conference for Nurse Practitioners (NCNP) | Exhibiting at Booth #301
https://www.ncnpconference.com/ehome/index.php?eventid=309462&

Sept 26-29 – Gerontological Advanced Practice Nurses Association (GAPNA) Annual Conference | Exhibiting at Booth #219
https://www.gapna.org/events/annual-conference

Oct 9-11 – Coalition to Transform Advanced Care (C-TAC) hosts the National Summit on Advanced Illness Care | Presenter and Exhibitor
https://www.ctacsummit.org/

Oct 25-27 – American Academy of Home Care Medicine (AAHCM) Annual Meeting | Presenting the Preconference on 9/25 and Exhibitor
https://www.aahcm.org/page/2018_Annual_Meeting

Hope to see and meet you out on the conference trail!