The PCPCC commends today's Supreme Court ruling on King v. Burwell, which represents a huge win for millions of patients and families who qualify for subsidies to purchase health insurance on the federal insurance exchange. In a 6-3 decision penned by Chief Justice Roberts, the US Supreme Court upheld that subsidies must be available to all individuals shopping for insurance on the exchanges, regardless of whether the exchange is operated by a state or the federal government. 

This landmark decision marks a critical victory for efforts underway nationwide to increase access to comprehensive primary care services. As the PCPCC works to ensure a transformation in the way we delivery primary care, this court decision will support and advance opportunities to afford all Americans access to a primary care patient-centered medical home. 

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Founded in 2006, the Patient-Centered Primary Care Collaborative is a 501(c)(3) membership organization dedicated to meeting the Triple Aim by advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. The PCMH model embraces the relationship between primary care providers and their patients, families, and care-givers; promotes authentic communication and patient engagement; and coordinates whole-person, compassionate, comprehensive, and continuous team-based care; all of which are crucial to achieving meaningful health system transformation that improves outcomes and lowers costs. Today, the Collaborative’s membership represents more than 1,200 medical home stakeholders and supporters throughout the United States and we track more than 500 local, regional, state and national advanced primary initiatives on our Primary Care Innovations and PCMH Map

FOR IMMEDIATE RELEASE
June 5, 2015

CONTACT: Lisabeth Buelt
lisabeth@pcpcc.net | (202) 417-3911

An important study regarding the patient-centered medical home (PCMH) model of care was published in JAMA Internal Medicine this week: Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care. RAND researcher Dr. Mark Friedberg and colleagues found that a large multi-payer PCMH program achieved significant reductions in unnecessary health care utilization as well as notable improvements in quality of care. This is welcome but not surprising news: when primary care practices are incentivized to curb costs and improve health and are given adequate time and support to implement the PCMH model of care, the results speak for themselves.

The study evaluated the northeast region of the Pennsylvania Chronic Care Initiative (PA-CCI), a PCMH pilot program that began in October 2009. During the three-year study period, PCMH practices performed better than non-PCMH comparison practices in all four examined measures of diabetes care, as well as breast cancer screening. In addition, PCMH practices had lower rates of patient hospitalization (-1.7), emergency department use (-3.2 to -4.7), and reductions in specialty care (-17.3), as well as an impressive increase in the rate of primary care visits (+77.5).

These findings are particularly significant because the same authors published an article in JAMA in February of 2014 that evaluated the same Pennsylvania program, but reported very different results. The 2014 study found that the PCMH model was unsuccessful in achieving reductions in cost or utilization, and failed to yield improvements in quality of care. The JAMA article generated widespread skepticism that the PCMH could deliver on the promise of better health care at a lower cost, despite the continued publication of positive findings linking the PCMH with the Triple Aim.
 
Although they used the same methods in both evaluations, in the most recent study – which looked at more mature PCMH practices in a different part of the state – authors suggest several factors contributing to their success. 

• PAYMENT INCENTIVES. First, shared savings incentives for PCMH providers were incorporated that allowed practices to receive bonuses if total spending on patients was less than expected for the year.
• TIMELY DATA. Second, the practices received regular feedback from participating health plans, allowing for practices to continuously modify their efforts to meet benchmarks. 
• PRACTICE TRANSFORMATION FOCUS. Third, financial incentives were NOT tied to early achievement of medical home recognition, which potentially allowed practices to focus more on process improvement and learning collaborative activities. 
• ELECTRONIC HEALTH RECORD ADOPTION. Fourth, all practices entered into the pilot with an electronic health record in place, preventing distractions from improving patient care. 
• ADVANCED PRIMARY CARE. Fifth, the practices were more advanced, per their NCQA recognition scores, which better positioned them to implement case management and other advanced capabilities.

As a broad coalition of health care providers, purchasers, and patients dedicated to advancing the medical home, the PCPCC believes this significant contribution to the scientific evidence offers critical lessons. It also underscores recent achievements in payment reform. With the recent passage of bipartisan legislation to repeal and replace Medicare’s Sustainable Growth Rate (SGR) physician payment formula, incentives for PCMH adoption as an approved care delivery and alternative payment model will be included in Medicare. This legislation will be fundamental in achieving goals announced this January by the Secretary of Health and Human Services, including tying 30 percent of Medicare payments to value through alternative payment models by 2016, and 50 percent by 2018.

Moving forward, the PCPCC will continue to aggregate PCMH program evaluations to expand upon the growing evidence base that associates the PCMH with the Triple Aim of achieving cost savings, while improving population health and quality of care. Friedberg’s study, one of many, helps us understand key components of advanced primary care that are needed for practices to achieve success. These findings offer positive news for primary care practices, patients, families, and caregivers as well as purchasers and payers of the U.S. health system. 

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About PCPCC: Founded in 2006, the Patient-Centered Primary Care Collaborative (PCPCC) is dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home (PCMH). The PCMH model embraces the relationship between primary care providers and their patients, families, and care-givers; promotes authentic communication and patient engagement; and coordinates whole-person, compassionate, comprehensive, and continuous team-based care; all of which are crucial to achieving meaningful health system transformation. The PCPCC achieves its mission through the work of its five Stakeholder Centers, led by experts and thought leaders who are dedicated to transforming the U.S. health care system through delivery reform, payment reform, patient engagement, and employee benefit redesign. Today, PCPCC’s membership represents more than 1,200 medical home stakeholders and supporters throughout the United States.

WASHINGTON - The Patient-Centered Primary Care Collaborative (PCPCC) congratulates the House of Representatives for passing the SGR Repeal and Medicare Provider Payment Modernization Act of 2015 (HR 1470). Today’s vote was an incredible sign of bipartisanship, with 397 members voting in favor of the bill. Now, we are urging the Senate to follow the House’s lead and officially repeal SGR and transition to a new, dual system intended to reward quality of care. After 17 patches in 12 years, it is time to stabilize Medicare physician payment system and provide health security to the most vulnerable members of the population.

This historic legislation marks numerous accomplishments. First, it will end the disruptive last minute “fixes” that threaten deep cuts to physician reimbursement year after year.  Next, the bill replaces the SGR with a new dual reimbursement system under which physician practices could choose to participate in either a Merit-Based Incentive Payment system linking better overall performance to higher reimbursement, or an “Alternative Payment Model” (APM) system under which practices would move away from traditional fee-for-service payments toward value-based payment.

Since the inception of the PCPCC, we have been aligning our stakeholders to promote sustainable payment for advanced primary care models, such as the patient-centered medical home (PCMH). As a long-time supporter of value-based reimbursement, we are pleased to see the legislation recognize the PCMH as an APM method for improving access to continuous, coordinated, and patient-centered primary care. The bill also provides support to primary care practices as they redesign their care delivery models to support valued-based services and meaningful partnerships with patients and families that help them achieve their health goals.

Finally, the legislation provides continued support for other important programs. It reauthorizes the Children’s Health Insurance Program to ensure the continued health care coverage of low-income children, and extends the Teaching Health Center Graduate Medical Education Program that provides care to patients in underserved areas by training primary care physicians in community-based settings. Both were set to expire in September. It also extends for two years funding for Community Health Centers and the National Health Service Corps.

As a leading advocate for advanced primary care and the PCMH, we appreciate the House’s action to repeal the flawed SGR formula and applaud the White House for signaling their support of this historic, bipartisan legislation. We urge the Senate to act quickly to pass this bill by replacing it with a fair and stable Medicare physician payment system that builds on private and public sector initiatives that move America toward comprehensive payment reform.

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About the Patient-Centered Primary Care Collaborative (PCPCC): Founded in 2006, the PCPCC is dedicated to advancing an effective and efficient health care system built on a strong foundation of primary care and the patient-centered medical home (PCMH). The PCPCC achieves its mission through the work of its five Stakeholder Centers, experts and thought leaders focused on key issues of delivery reform, payment reform, patient engagement, and employer benefit redesign to drive health system transformation. For more information, visit www.pcpcc.org.

FOR IMMEDIATE RELEASE
March 23, 2015

CONTACT:
Caroline DeLaney
caroline@pcpcc.org | (352) 258-0090

WASHINGTON - The Patient-Centered Primary Care Collaborative (PCPCC) applauds the SGR Repeal and Medicare Provider Payment Modernization Act of 2015 (HR 1470). After 17 patches in 12 years, it is time to stabilize the Medicare physician payment system and provide health security to some of our most vulnerable members of the population who depend on consistent care from their health care providers.

In addition to protecting the elderly and the disabled, the legislation supports two important programs. First, it extends the Children’s Health Insurance Program (CHIP), currently set to expire in September, to ensure the continued health care coverage of low-income children. Second, it extends the Teaching Health Center Graduate Medical Education Program that provides care to patients in underserved areas by training primary care physicians in community-based settings.

If passed, the legislation would prevent the disruptive last minute “fixes” that threaten deep cuts to physician reimbursement year after year. Instead, clinicians would receive an annual 0.5 percent payment increase through 2019, creating long-term stability for the health care community. 

Replacing the SGR with a stable payment system would move the U.S. health care delivery system away from the current volume-based reimbursement payment system to one that rewards quality, efficiency, and innovation. We were pleased to see the patient-centered medical home (PCMH) recognized as a way to improve access to continuous, coordinated, and patient-centered primary care for all patients, and for its ability to improve care and lower costs for patients with complex chronic diseases. We were also happy to see that the bill provides support to practices as they redesign their care delivery model, especially in primary care, to support valued-based services and meaningful partnerships with patients and families to help them achieve their health goals.

We urge Congress to act quickly and pass HR 1470. With bipartisan, bicameral support, Congress has an incredible opportunity to remove a flawed and inefficient system, promote the shift to value-based reimbursement, and most importantly, improve health care for some of the most vulnerable members of the population.

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About the Patient-Centered Primary Care Collaborative (PCPCC): Founded in 2006, the PCPCC is dedicated to advancing an effective and efficient health care system built on a strong foundation of primary care and the patient-centered medical home (PCMH). The PCPCC achieves its mission through the work focused on key issues of delivery reform, payment reform, patient engagement, and employer benefit redesign to drive health system transformation. PCPCC’s membership represents more than 1,200 medical home stakeholder organizations and supporters throughout the country. For more information, visit www.pcpcc.org.