Federal Policy Updates

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The PCC Joins 188 Organizations In Calling for Congress to Pass the Stabilize Medicaid and CHIP Coverage Act (H.R. 5434 and S. 3138)

August 16, 2024

With an August 13th letter, the PCC joined a diverse group of 188 organizations calling on Congress to pass the bipartisan Stabilize Medicaid and CHIP Coverage Act (H.R. 5434 and S. 3138). 

Medicaid and CHIP provide vital health care coverage to over 80 million Americans. As primary care clinicians and patients discovered amid the unwinding of COVID-19 protections, this coverage is at risk for millions of Medicaid and CHIP beneficiaries because there are no safeguards in place to protect beneficiaries from losing their coverage when they are required to re-enroll or have a slight change in income. Any gap in coverage can create barriers to essential primary care access, and frustrate the implementation primary care payment reform.

Medicaid and CHIP coverage must be stabilized to ensure that millions of Americans have access to high-quality health care. A nationwide policy of 12-month continuous eligibility for all adults in Medicaid and CHIP will allow for continuous and stable enrollment without risk of losing coverage.

You can read our full letter below:

Better Health - NOW Replies to RFI on Pay PCPs Act

July 16, 2024

The Primary Care Collaborative and our Better Health - NOW partners have responded to the Request For Information process set out by Senators Whitehouse and Cassidy in response to their introduction of S.4338, the Pay PCPs Act, which seeks to create a hybrid payment system for primary care inside of Medicare Part B. For PCC and our Members, primary care should be at the very center of a well-functioning American health care system.

The evidence is crystal clear that primary care reform can unlock both powerful improvements in patient health and real cost savings. Major studies have shown that high-quality, comprehensive primary care is an essential component of any national strategy to address chronic physical and mental health conditions and the constant, unaffordable costs they generate.

That is why our Better Health – NOW Campaign supports efforts to rapidly transition primary care payment from a fee-for-service (FFS) approach to one based upon prospective population-based payment (hybrid) models which include upfront and ongoing investments, as well as guardrails to assure quality and access in both rural and underserved communities. 

As the Senators suggest in their legislation, structural reforms of Medicare payment being debated in the Finance Committee must be accompanied by hybrid payment paradigms for primary care. As work proceeds on this broader package, the zero-sum budget neutrality requirements applicable to the Physician Fee Schedule should not be allowed to undermine the scope and viability of substantial reforms to Part B payment with primary care at the center.

Our RFI response to Senators Whitehouse and Cassidy outlines 6 principles which a primary care hybrid payment paradigm should reflect. We also say that, at a minimum, any legislation creating a hybrid payment structure should include patient cost-sharing waivers which is key to removing barriers to care. Remember, primary care is the only part of the health system where additional resources lower costs - to people, to taxpayers and to families.

Today, a vicious cycle of foregoing preventive care, resulting in unnecessary ED visits, and ultimately avoidable hospitalizations end up degrading beneficiaries' health and eroding the fiscal solvency of Medicare. Access to primary care can reverse this pattern and both hybrid payment and cost-sharing reductions can help with these long-term structural problems.

When it comes down to it, payment policies supporting comprehensive primary care, including the integration of behavioral health, are an important step toward strengthening primary care for all Americans. We look forward to continuing to work with Senators Whitehouse and Cassidy, their colleagues and Members of both sides of the aisle to bring deeper and smarter investment to the front door of America's health care system. 

PCC, Partners Brief Capitol Hill on Primary Care and Needed Payment Reforms

June 28, 2024

On June 18, the Primary Care Collaborative (PCC) hosted a briefing for congressional staff and stakeholders, Charting the Course: Transforming Primary Care for Tomorrow, in partnership with the Bipartisan Policy Center (BPC) and The Commonwealth Fund. The briefing kicked off with a panel discussion and included remarks from Senator Sheldon Whitehouse (D-RI), who recently joined with Senator Bill Cassidy (R-LA) on bipartisan primary care legislation along with a request for information from stakeholders.

The panel featured National Alliance of Healthcare Purchaser Coalitions President and CEO Shawn Gremminger; Partnership for a Healthy Lincoln President Dr. Bob Rauner; and Associate Professor of Medicine at the Perelman School of Medicine Matthew Press.

Throughout the panel, moderated by BPC’s Chief Medical Advisor Dr. Anand Parekh, speakers underscored the importance of high-quality primary care in building an equitable and effective health care system.

Panelists agreed that Americans increasingly lack access to the high-quality, comprehensive primary care because payment systems with misaligned incentives continue to underemphasize primary care and prevention. The conversation underscored that this underinvestment was driving higher costs and undermining the health of communities across the nation.

As Gremminger noted, employers typically want to cut costs associated with health care, but primary care consistently stands out as one major area where employers want to invest more because of the long-term, positive impact of that primary care.

Following the panel, PCC President and CEO Ann Greiner introduced Senator Whitehouse.

In his remarks, Whitehouse stressed the importance of investing in primary care and crafting common-sense, bipartisan legislation to improve our primary care system. Whitehouse and Cassidy’s bill, The Pay PCPs Act (S. 4338), aims to better support and improve pay for primary care clinicians. PCC has been heartened by the embrace of hybrid payment and patient affordability policies included in the bill and has appreciated the senators’ efforts to engage stakeholders.

Amid the growing discourse around Medicare payment reform on Capitol Hill, this successful briefing highlighted the pivotal role primary care has to play. Alongside other recent PCC activities, it signifies a growing recognition of the urgent need to address and enhance primary care services to improve overall health care outcomes.

To build on the momentum, PCC’s Better Health – NOW Campaign plans to respond to the Whitehouse/Cassidy RFI, drawing on the principles for a broadly available hybrid payment articulated in its response to the Senate Finance Committee’s White Paper. PCC strongly encourages PCC members and others to respond as well. Responses must be submitted to physician_payment@cassidy.senate.gov by July 15, 2024.

Primary Care Must be at the Center of Medicare Payment Reform

June 24, 2024

Today, under the leadership of United States Senate Committee on Finance Chair Senator Ron Wyden and Senator Mike Crapo, lawmakers in Washington are considering sweeping changes to how Medicare pays for chronic care and for Part B benefits.

These conversations are an important first step in shifting from a convoluted, ineffective sick care system to one focused on promoting better health, and the Primary Care Collaborative is grateful to the Senators -- and their lead staffers Marisa Salemme and Conor Sheehey -- for their efforts to find a bipartisan solution to major challenges facing the American health care system.

But as lawmakers weigh these important changes, it’s essential they place primary care at the center of their efforts. Primary care is the only area of health care where stronger investment can both reduce costs and improve outcomes for patients.

Late last week, in a response to a Senate Finance Committee RFI on chronic care, the Primary Care Collaborative (PCC) emphasized primary care’s central role in curbing chronic conditions and provided concrete policy solutions to strengthen primary care.

In its response, the PCC noted that, "High-quality, comprehensive primary care is an essential component that must be part of any national strategy to address chronic physical and mental health conditions and the constant, unaffordable costs they generate."

Download Letter

PCC also emphasized the important role of hybrid payments in bolstering primary care – an approach that would empower primary care clinicians to build the teams they need to deliver higher quality care to patients, provided they are built with the following 6 principles in mind:

  1. Allow for cost-sharing waivers to apply to primary care services reimbursed through a population-based hybrid payment
     
  2. Allow for payment adjustments that account for clinical and social risk, in order to support primary care teams made up of different types of clinicians
     
  3. Tier the value of payment based on the scope of services provided
     
  4. Make a higher tier payment available to clinicians that integrate behavioral health and social care
     
  5. Incorporate sufficient support to increase behavioral health referrals and screening for SDOH
     
  6. Create an accountability framework that supports quality improvement

In the coming weeks, PCC and our Better Health –NOW partners look forward to working with Members of Congress on both sides of the Capitol and in both parties to place primary care where it should be at the very center—of our health care system.

Applications Now Open for MSSP Hybrid Pay Model Sought by PCC

May 31, 2024

Applications opened for ACOs and their primary care partners to join the new ACO Primary Care Flex, but PCC and its Better Health – NOW (BHN) partners continue to urge CMS to strengthen the model during implementation.

A May 9th BHN letter conveyed appreciation for the new ACO Primary Care Flex Model, scheduled to start January 1, 2025, and offered specific recommendations aimed at successful implementation.

The letter, addressed to Center on Medicare Director Meena Seshamani and CMS Innovation Center Director Liz Fowler, called the model, a “substantive step to strengthen primary care for beneficiaries” and highlighted CMS’ commitment to guardrails that assure the model’s investments reach primary care.

However, the letter also highlighted opportunities to strengthen the model during implementation, including the following recommendations:

  • Ensure affordability of primary care by offering additional cost-sharing relief for beneficiaries
  • Continue dialogue with front-line clinicians and beneficiary advocates, as well as eligible ACOs, during implementation
  • Track behavioral health and social care integration service utilization and expenditures, beginning in the model’s first year, and establish enhancements to the prospective, population-based payment components of the model for those practices that routinely furnish those services

ACO Primary Care Flex’s ACO PC Flex’s launch came less than a year after PCC and 30 other health care organizations urged CMS leaders to implement a hybrid program under MSSP.

PCC and its partners in the Better Health – NOW Campaign will be reviewing the details of the newly released Request for Applications.  As implementation proceeds, we will continue to engage with CMS leaders to ensure the model delivers meaningful opportunities for patients and primary care.

Finance Committee White Paper Offers Opportunity to Bolster Seniors’ Primary Care

May 20, 2024

FOR IMMEDIATE RELEASE
Media Contact: Tod Didier
tdidier@thepcc.org | 202-417-2069
 

Washington, D.C. (May 20, 2024) – The Primary Care Collaborative (PCC) thanks Senator Wyden and Senator Crapo for highlighting options to strengthen primary care for seniors and people with disabilities in their white paper, Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options for Medicare Part B.

PCC was encouraged to see lawmakers considering a hybrid payment model for primary care under traditional Medicare – an important change to expand access to high-quality, comprehensive primary care, improve health outcomes and generate cost-savings for Medicare.

“Every day it becomes harder and harder for people to find a primary care clinician and team they trust,” said Ann Greiner, President and CEO of the Primary Care Collaborative. “Introducing hybrid models will help bolster the primary care workforce and expand seniors’ access to high-quality, comprehensive primary care.”

Friday's white paper adds to the momentum behind the hybrid primary care payment proposals, sought by the PCC, its Better Health — NOW partners and Senators Whitehouse and Cassidy, who recently introduced the Pay PCPs Act (S. 4338). That legislation would ensure all Medicare primary care practices have access to hybrid payment models – giving them the flexibility they need to deliver better care to patients.

“The evidence is crystal clear: giving primary care viable alternatives to fee-for-service leads to better health and greater cost savings for Medicare,” said Greiner.

As noted by the Finance Committee’s white paper:

  • Independent evaluations found that earlier primary care models kept Medicare beneficiaries out of the ED and away from unnecessary hospitalizations - with the best results from independent and ACO-associated practices.
     
  • CBO's latest report found primary care-centric ACOs achieve twice the savings of others.  
     
  • ACOs with hybrid payments—including participants in the soon to be launched (Jan 25) ACO Primary Care Flex model announced by the CMS Innovation Center—can be an important pathway for shifting primary care away from per-visit volume and towards a more predictable and greater investment in primary care. 

PCC looks forward to working with Chairman Wyden, Ranking Member Crapo and all the members of the Finance Committee to advance their goals this year.

About the Primary Care Collaborative

Founded in 2006, the Primary Care Collaborative (PCC) is the leading national, nonpartisan and multi-stakeholder voice advocating for better health for all Americans by strengthening primary care. The PCC unifies and engages diverse stakeholders in promoting policies and sharing best practices that encourage the growth of high-quality, comprehensive primary care.

PCC Encouraged by Lawmakers Championing Hybrid Payments

May 15, 2024

Washington, D.C. (May 15, 2024) – Ann Greiner, President and CEO of the Primary Care Collaborative, issued the following statement regarding the introduction of the Pay PCPs Act of 2024 by Senator Sheldon Whitehouse (D-RI) and Senator Bill Cassidy (R-LA):

“We’re heartened to see Senator Whitehouse and Senator Cassidy’s bipartisan commitment to improving seniors’ access to comprehensive primary care by proposing legislation that would offer hybrid payment (a mix of FFS and prospective payment) to Medicare primary care practices.

With our Better Health-NOW Campaign partners, we’ll respond to the Request for Information and look forward to working with Senator Whitehouse, Senator Cassidy and their peers to secure bold reforms that strengthen primary care.”

As demonstrated by CBO reports and the best research, well-designed primary care payment reforms can unlock powerful improvements in health outcomes and a more affordable health care system.

About the Primary Care Collaborative

Founded in 2006, the Primary Care Collaborative (PCC) is the leading national, nonpartisan and multi-stakeholder voice advocating for better health for all Americans by strengthening primary care. The PCC unifies and engages diverse stakeholders in promoting policies and sharing best practices that encourage the growth of high-quality, comprehensive primary care.

CMS Finalizes Medicaid Primary Care Access Standards sought by Better Health — NOW

April 30, 2024

In a win for tens of millions of children, adults and communities that rely on Medicaid and CHIP, CMS has finalized new primary care access standards  long sought by PCC and our Better Health – NOW Campaign.

Under new federal transparency requirements, state Medicaid programs and plans must publish comparisons of primary care payment against payment rates from Medicare and other payers.  CMS also finalized proposals to strengthen beneficiaries’ voice in state Medicaid program governance and to address health related social needs through In-Lieu-of-Services payments. 

“The transparency requirements will spotlight the glaring disparity between Medicaid primary care payment rates and other health plans – a disparity that hits rural and underserved communities the hardest,” said Larry McNeely, PCC's Director of Public Policy . Independent analysis from the Urban Institute has estimated that primary care rates are just 67% of Medicare’s.

“The onus then falls on federal and state policymakers to leverage the new transparency to actually close those gaps, and on primary care stakeholders to make them do it,” added McNeely.

CMS’ announcement follows BHN’s two years of persistent engagement, dating from PCC's Medicaid RFI response in April 2022, through 2023 comments on the proposed rules, to the January 2024 release of Better Health – NOW’s Medicaid Priorities.

Better Health – NOW, a Campaign of the Primary Care Collaborative, has identified reducing economic and social barriers through stronger Medicaid and CHIP primary care as a core policy goal.  To learn more about the Campaign, click here. 

Primary Care Champions: Dr. Meena Seshamani and Liz Fowler

April 30, 2024

This month, the Primary Care Collaborative is thrilled to honor two leaders from the Center for Medicare and Medicaid Services (CMS) as its Primary Care Champions:

Dr. Meena Seshamani, Deputy Administrator and Director of the Center for Medicare; and Liz Fowler, Deputy Administrator and the Director of the CMS Innovation Center.

As leaders at CMS, Meena and Liz and their teams at the Center for Medicare and CMS Innovation Center have collaborated to champion thoughtful and innovative approaches to improve seniors’ access to high-quality, whole-person primary care.

“It’s so important that we have primary care doctors that are supported and able to care for people the way they want to be cared for,” said Meena in a short interview with PCC. “It’s been very important to me… to support primary care because it really serves as a cornerstone and foundation for how we want to innovate, to provide whole-person care to everybody in our country.”

Their commitment is driven by their recognition of the essential role that primary care plays in care management and prevention.

“We know that people who have access to high-quality primary care are more likely to receive preventive health services and screenings and to experience improved health outcomes related to mortality, disease progression, and chronic condition management,” said Liz in the same interview.

Under Meena and Liz’s leadership, the Center for Medicare and CMS Innovation center have worked together on myriad efforts to strengthen payment policies for primary care both in new models and in the underlying Medicare program — most recently with the launch of the ACO PC Flex hybrid payment model under the Medicare Shared Savings Program (MSSP).

ACO PC Flex’s launch came less than a year after PCC and 30 other health care organizations urged CMS leaders to implement a hybrid program under MSSP.

Meena cited the ongoing success of existing primary-care centered ACOs as a major motivator for developing the program, noting that primary-care led ACOs share in nearly double the savings of other ACOs.

The new payment model is designed to encourage primary care practices to participate and lead in ACOs.

“The models flexible payment design is intended to empower participating ACOs and their primary care providers to use more innovative team-based, patient-centered and proactive approaches to delivering care,” said Liz.

The PCC is grateful to Meena, Liz and the teams at the Center for Medicare and CMS Innovation Center for their ongoing commitment to advancing the promise of primary care.

Click here to learn more about the ACO PC Flex program.

Click here to watch PCC’s webinar exploring the program with CMS Innovation Director Liz Fowler.

Better Health NOW:  Primary Care Must Be At Center of Payment Reform Bill 

April 29, 2024

On April 24th, the Primary Care Collaborative and its Better Health – NOW Campaign urged the U.S. Senate Finance Committee to put primary care at the center of planned Medicare payment legislation. 

“To address the rising tide of chronic disease discussed…,policymakers must fix the underlying flaws in Medicare Part B’s payment policies,” according to a  Statement for the Record submitted for the April 11th hearing, Bolstering Chronic Care Through Medicare Payment. 

The Campaign’s statement called for reorienting Medicare to support primary and preventive care: 

  • Require Medicare and other federal programs to report primary care expenditures as a percentage of overall health care dollars 

  • Establish a well-constructed hybrid payment option, broadly available to Medicare primary care 

  • Make Medicare more affordable for beneficiaries, removing cost-sharing for primary care hybrid payments, chronic care management and behavioral health integration services 

  • Accelerate Primary Care-Behavioral Health Integration in Medicare, through bipartisan legislation like the COMPLETE Care Act  

Noting that the success of any Medicare payment reform depends on alignment with other payers, Better Health – NOW also encouraged the Finance Committee to advance targeted policy steps this year that support constructive state Medicaid and private market primary care innovations - including community health center funding, youth mental health improvements and improved coverage for primary care in high-deductible health plans. 

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