New Mexico

The patient, pleading for pills, set off alarm bells in the doctor’s head.

When abused, the anti-seizure drug the patient was seeking can produce a euphoric high. Was the patient battling an addiction?

On a computer, the doctor searched a database for the patient’s electronic record, including any recently prescribed narcotics.

As the health care system moves toward more sophisticated value-based payment (VBP) models, those seeking to improve efficiency continue to look to primary care as the key to prevention and better health management. And for good reason: greater use of primary care is associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality.

As the health care system looks to improve overall health and reduce unnecessary spending, primary care physicians become increasingly critical. The Affordable Care Act (ACA) recognizes that primary care clinicians have the potential to “bend the cost curve” through care coordination and preventive health care for our increasingly diverse and aging population. However, there aren’t enough primary care physicians to meet this need — especially in rural or poor urban areas.

As states look at how to provide high-quality, affordable care to Medicaid beneficiaries, more are turning to Medicaid managed care for the care coordination and support Medicaid health plans provide for millions. Nearly two-thirds of all Medicaid beneficiaries rely on Medicaid health plans for their coverage.

Those seeking to reform oncology reimbursement for physicians have set lofty goals: create an equitable method for reimbursing oncologists for the entire continuum of care of these complex patients, and provide better care for patients— reducing adverse events, emergency department (ED) visits and hospitalizations, while lowering the overall cost of cancer treatment in America.