What the Government Should Do
Ensure government payment policies recognize the value of primary care
The existing fee-for-service payment systems must be changed to place greater value and emphasis on primary care, including care coordination. As policymakers consider options for overhauling the current Medicare physician payment formula, primary care services must be protected from payment reductions resulting from increased utilization of specialty care services. Payments must be sufficient to ensure continued access to physicians and other providers as the Medicare population grows, and to prevent cost-shifting from one program or payer to another.
Align federal delivery system reform initiatives with private sector best practices to promote primary care
The government should review and leverage private sector efforts that place a high value on primary care and care coordination, which improve the patient experience and healthcare outcomes.
As accountable care organizations and patient-centered medical homes continue to evolve in Medicare, the government should maintain critical design elements - such as quality measures that are largely outcomes-based and closely aligned with private sector best practices - to assure that quality improvement and system-wide savings can be achieved and maintained. In time, beneficiaries enrolled in these programs should be encouraged to consult with primary care practitioners before seeking specialty care. The government should use incentives to manage overall care, which in turn will drive greater accountability and improvement.
Improve care for “dual eligibles” and others by promoting managed care
Millions of new individuals are expected to enroll in Medicaid within the next five years, underscoring the importance of building greater value into this state-federal partnership. Medicaid managed care applies private sector innovations to foster better health outcomes for beneficiaries through improved access to primary care, preventive services and care coordination.
The federal government and states should continue to focus on improving healthcare outcomes, reducing unnecessary utilization, improving access to services and achieving greater continuity of care by expanding Medicaid managed care. Particularly for “dual eligibles” enrolled in both Medicare and Medicaid and for the Aged, Blind and Disabled (ABD) Medicaid population, there is substantial opportunity to improve quality and reduce costs by better managing healthcare services. While a majority of Medicaid beneficiaries currently are served through managed care, these two cohorts largely remain in fee-for-service programs.
Use federal dollars wisely to leverage the full primary care workforce
More focus should be placed on incentives to support and increase the primary care workforce. The government should redirect training resources from hospital-based specialty programs to those geared toward primary care, including non-physician practitioners and allied health professionals. In an effort to assist beneficiaries in managing their healthcare needs, registered nurse care management consultants should be available to beneficiaries through the 1-800-MEDICARE call line. Medicare should analyze program data to identify populations and communities at high risk for gaps in care and should test the impact of targeted care management services and higher reimbursement for primary care physicians working to close these gaps.
Evaluate the impact of provider consolidation on access to high-quality primary care
To assure a robust, high-quality primary care marketplace, the government should remain vigilant of the impacts of provider consolidation. Ongoing analysis should assess and monitor the relationship between provider consolidation and healthcare access, quality and pricing.
