December 2019

• Christopher Koller, President, Milbank Memorial Fund, who received the prestigious Barbara Starfield Primary Care Leadership Award; 
• The Primary Care Development Corporation (PCDC), who received the Advanced Primary Care Practice Award; and
• Matt Probst, PA-C, Chris Ruge, FNP, and Leslie Hayes, MD of El Centro Family Health, who received the Primary Care Community Leadership Award

• This month, Washington state transmitted its Primary Care Expenditure Study Report to the state legislature. Primary care expenditures ranged from 4.4% (narrow definition) to 5.6% (broad definition) of total medical expenditures, with percentages largely consistent across  public employee, Medicaid, and commercial coverage. 
• PCC convened its quarterly call of the Primary Care Investment workgroup with over 60 individuals joining the discussion in November. Topics included: the MA Primary Care Investment Working Group’s list of 16 ideas for investment; an update from the New England States Consortium Systems Organization on their steps to create a standardized primary care report; and Milbank’s contracted work with RAND to develop non-fee-for-service claims specifications to enhance primary care spend measures. 
• Primary care investment was also featured throughout PCC’s annual conference, including a panel on primary care state investment featuring updates from VT, CO, and RI, as well as a breakfast with individuals involved in state-level policy efforts to discuss their successes and challenges. A longer in-person meeting on the topic of primary care investment is being planned for next year’s PCC conference.
• HCCI Study Shows Stagnant Primary Care Investment—Even as PCC continues to advocate for increased investment in primary care—and an increasing number of states pursue it—this remains a pressing issue. A new study from the Health Care Cost Institute shows slightly declining rates of primary care spending as a share of total spending. The research letter, published December 10th in JAMA, analyzed employer-sponsored insurance data from three national payers, finding that share of total spending attributed to primary care declined between 2013 and 2017 using either a broad definition (from 8.97% to 8.04%) or narrow definition (from 4.60% to 4.35%). Though minimal declines, both were statistically significant. The study found that utilization of primary care clinicians increased over the same period.

CMS Direct Contracting RFA released—At the end of November, CMS released its Request for Applications (RFA) for the Direct Contracting Global and Professional Risk models. The models offer practices the opportunity to participate in an advanced accountable care model, with 50% risk sharing (Professional) or 100% risk sharing (Global). A third model, Geographic, will be released soon. The models offer two payment options: either a primary care capitation (7% of Part A & B) or total care capitation (100%). The 5-year performance periods begin 2021 with an optional implementation period in 2020. Applications to participate in the implementation period are due February 25, 2020, open to any entity that already submitted a non-binding letter of intent. Visit CMS’s webpage to learn more about eligible direct contracting entities, beneficiary thresholds, financial incentives and more.

Final Physician Fee Schedule released—The final 2020 Medicare Physician Fee Schedule was released November 1. The rule provides welcome increases to office/outpatient E/M values for primary care and non-procedural specialty care and allows clinicians to choose the E/M visit level based on either medical decision making or time. Other positive additions include: a new Medicare Part B benefit for OUD treatment services; reduction in EHR documentation burden; and more flexible supervision requirements for PAs. 
 
Primary Care Support in Senate LHSS Appropriations Report—Earlier this fall, the Senate Labor-HHS Appropriations Report was issued; the report states the Committee’s support for “primary care clinical research and dissemination as a core function AHRQ”. It also recommends $2,000,000 to support a study of state primary care demonstrations to learn from “states that have taken action aimed at improving the delivery of primary care.” Stay tuned to learn more as federal spending negotiations continue.

Most Recent Webinars: 

• Maria S. Kobylinski, Provider, Geisinger Health
• Heather Schultz, Pharmacy Benefit Manager, IngenioRx
• Shannon Brownlee, Policy Thought Leader, Lown Institute
• Julie Schilz, Senior Director, Mathematica

• Carolyn Clevenger, RN, DNP, Clinical Director and Nurse Practitioner, Integrated Memory Care Clinic, Emory University
• David B. Reuben, MD, Director, Multicampus Program in Geriatrics Medicine and Gerontology, University of California, Los Angeles
• Morgan Daven, MA, Senior Director for Health Systems, Alzheimer's Association
• Robert Dribbon, Strategy and Innovation, Merck, and Executive Committee Liaison to the Board of Directors of the Patient-Centered Primary Care Collaborative
   

Findings from Annual 50-State Medicaid Budget Survey

2019 Signature Series: Solving for Health | Navigating the Frontiers of Innovation and Value Summit

Consumer & Community Leadership: The Key to Better Health

Combating Chronic Conditions

Advancing Comprehensive Primary Care in Medicaid

Commonwealth Fund International Health Policy Survey Briefing