Primary Care First: CMS Develops a Value-Based Primary Care Program for Independent Practices.

The monumental shift in healthcare from fee-for-service or a volume-based approach to value-based care will change healthcare delivery for the better in the United States.  When physicians do what is necessary and avoid over-testing and procedures of limited or no value , the outcomes are best for the patient, and for the entire healthcare system.  After all, physicians are also stewards of the healthcare system.

The Centers for Medicare and Medicaid Services have tested and continue to test models in the delivery of value-based care. I was a practicing physician (internist and nephrologist) for 25 years before I founded MDVIP, the nation’s leading concierge medicine company.  One of my core beliefs in founding MDVIP was that if I had more time with each one of my patients, I could have a large impact on reducing acute hospitalizations, making  accurate  diagnoses, and  better control and coordinate care of chronic conditions to avoid acute episodes.  This turned out to be true, and MDVIP now has about more than 300,000 patients and about 900 participating physicians.  I’m biased, but I believe that MDVIP has had a significant impact on reducing healthcare spend in the US.  About 50% of my own patients were Medicare age.  If this ratio is applied to all MDVIP physicians, MDVIP’s focus on the doctor-patient relationship has played a part in reducing Medicare costs. 

CMS is launching a new initiative called Primary Care First.  Primary Care First emphasizes the doctor-patient relationship (i.e. more time with each patient), and as CMS states, “the model aims to improve the experience for beneficiaries by reducing administrative burdens so practitioners can spend more time with patient".  Doctors will be paid both a flat visit fee, as well as a monthly population-based fee based on the average risk score of the patients.  Physicians are able to share in the savings (up to a 50% bonus), and must also take on a small amount of risk (10%). The single outcome metric of Primary Care First in Year 1 is to reduce Acute Hospital Utilization, and starting in Year 2, CMS will also measure outcomes of Primary Care First by looking at controlling Hemoglobin A1c, controlling high blood pressure, providing colorectal screening, etc.  The outcomes measured by Primary Care First are essentially the same as the outcomes that we focused on at MDVIP.  I believe that Primary Care First is an exceptionally positive development for value-based care for the Traditional Medicare population.

Finally, doctors who remain in traditional Medicare are going to be paid the right way-  a model that rewards phone calls, e-mails , and all types of patient care coordination, with a small fee as well for the extra burden of office visits.

Primary Care First is a promising initiative at The Centers for Medicare and Medicaid Services, and I am confident that it will have a positive impact on healthcare delivery.

Robert Colton, MD is an internist and nephrologist.  He is the founder of MDVIP (acquired by Procter & Gamble in 2009), the Founder & Chairman of ClearlyDerm, and Founder & Chairman of VBC Ventures, his latest venture, working with physicians on value based care initiatives.