Elation Health is committed to supporting efforts that advance primary care into its essential role in our healthcare system. Though we advocate for primary care in a variety of ways and settings, we constantly look for new opportunities to take action. So when an important new initiative to fight for primary care came up, we jumped at the opportunity.
The U.S. Department of Health and Human Services (HHS) Initiative to strengthen primary health care was launched in September 2021 with the goal of developing a federal foundation to support advancement toward a goal state of primary care. This goal state envisions primary care doing three things: 1) supporting health and wellness through sustained partnerships with patients, families/caregivers, and their communities; 2) equitably providing first contact access to all, as well as whole person, comprehensive care over time, using interprofessional teams; and 3) coordinating and integrating care across systems, including other health care providers, public health, and community-based health promotion and social service organizations.
The Office of the Assistant Secretary for Health (OASH) is assembling a preliminary action plan to achieve this goal by working across HHS agencies and other federal departments, as well as inviting public input. In a public Request for Information (RFI), HHS has requested feedback to aid in developing an initial Action Plan, and identifying key strategies and prioritized actions to build a federal foundation for strong, accessible primary care.
Elation has partnerships with external collaborators, such as the American Academy of Family Physicians (AAFP) and Primary Care for America (PCfA), to conduct innovative research, participate in policy advocacy, raise public awareness, and contribute to other coordinated efforts aimed at empowering primary care. As a founding member of PCfA, we have joined forces with other prominent primary care leaders to back numerous key initiatives designed to empower primary care’s role in society, including several letters to the Biden administration and reports to Congress.
Similar to initiatives on which we have collaborated in the past, we advocated for primary care on a national level in our response to the RFI, which can be read in its entirety here. Our very own Director of Primary Care Advancement, Dr. Sara Pastoor, our VP of Practice Innovation, Manisha Goud, and external collaborators weighed in with three crucial pieces of feedback to send to HHS:
Make Primary Care a Great Career Choice; Create Incentives for Independent Practice Separate from Large Subspecialty Conglomerates
PCPs employed by subspecialty-driven health systems tend to refer patients further within the same system for more expensive care. These incentives are not aligned with the quadruple AIM and rob primary care of the opportunity to prevent wasteful, and often harmful, downstream spending. HHS needs to create a clear path from primary care residency to community-based independent primary care, with incentives for PCPs to take this path. Consolidation is bad for patients, payers, and PCPs, but it is often the path of least resistance for PCPs with no other guidance or options in rapidly consolidating markets. Provider consolidation in healthcare consistently leads to higher total costs of care. A national study found that physicians in the most concentrated markets charged 14% to 30% higher fees than those in the least concentrated markets.
Change the Way HHS Measures Primary Care Value
Primary care needs to be measured differently. Evidence shows that vital primary care functions are tied to better outcomes, and primary care specialties should be measured in a way that prioritizes these functions and reduces burnout. We recommend referencing the Measures that Matter initiative from the Center for Professionalism and Value in Healthcare/American Board of Family Medicine, especially the Person-Centered Primary Care Measure (PCPCM), a patient-reported outcome survey fully validated by NQF and an approved MIPS measure. This measure places no administrative burden on the practice, is easily deployed and reported, and allows patients to determine the amount of value they are experiencing based on 11 domains of unique primary care functions.
Expand Innovative Models like ACO REACH
The CMS Innovation Center recently announced the participants for ACO REACH, the updated version of the previous Direct Contracting model, which provided significant flexibility for innovative primary care groups who were able to take on financial risk for populations. Most importantly, there was a pathway for so-called “new entrants” and a strong focus on SDOH and health equity in care delivery. Unfortunately, many potential new entrant ACOs that seemed to fully meet model criteria were rejected from the program, and no additional information was provided about future opportunities to apply for participation. HHS and CMS should ensure significant transparency in the planning and implementation of innovative payment and care delivery models so that groups of innovative and forward-looking PCPs can view the models optimistically and join forces to affect change in their communities.
“Primary care is the lifeblood of our healthcare system. Primary care physicians get to know a patient over time, building a sustainable relationship. This helps intercept health problems before they become monumental and creates a partner to help manage bigger problems if they arise. This is where the independent primary care physician thrives, but in our current healthcare system, this relationship is under attack and has been undermined for a long time.” -Kyna Fong, PhD
Elation Health is committed to our ongoing efforts to strengthen independent primary care in the United States and we are proud to be leading the charge in demonstrating the power of primary care to mend our broken healthcare system. What do you think of the new HHS initiative and Elation’s suggested actions? Share your thoughts below.