Medicare Just Invited More Competitors Into Value-Based Primary Care

Dennis Butts, HealthLeaders

The shift to value-based care has sputtered a bit in the past two years, as hospitals and health systems have waited to see what innovative reforms the Trump administration would push across the healthcare policymaking finish line.

Despite a litany of attempts — and two years of a Republican-controlled Congress — the administration has neither repealed nor replaced the Affordable Care Act and the value-based payment provisions embedded within it. Even with its individual mandate neutralized and its constitutionality under judicial review, the ACA remains law, and officials in the Centers for Medicare & Medicaid Services (CMS) are using the ACA's authority to roll out a potentially transformative undertaking: the CMS Primary Cares Initiative.

The initiative, which CMS announced last month, has a total of five voluntary payment model options split between two paths. There are two options under the Primary Care First (PCF) path and three options under the Direct Contracting (DC) path. The idea behind all five options is to demonstrate how risk and reward can lead to investment in primary care that ultimately reduces overall healthcare spending and boosts quality outcomes.

While there are still key details we don't know about how the new models will operate, they appear to present opportunities for healthcare providers that are strategically positioned to make big moves in value-based primary care.

But there also seem to be significant threats, including potential competition from some unlikely sources.

Read Full Article: Medicare Just Invited More Competitors Into Value-Based Primary Care

About the Experts

Back to top