A national primary-care physician association and an employer group have teamed up to develop a care model that aims to shift away from fee-for-service reimbursement.

The American Academy of Family Physicians and National Alliance of Healthcare Purchaser Coalitions plan to leverage regional employer coalitions and physician networks to form a national primary-care model based on a prospective payment system, although the specifics of which have not been hammered out. The partnership builds on the efforts of organizations like the Pacific Business Group on Health, the Connecticut Business Group on Health, Houston Business Coalition on Health, Memphis Business Group on Health, Pittsburgh Business Group on Health, Rhode Island Business Group on Health and Washington Health Alliance, executives said, emphasizing that it won’t be a one-size-fits-all approach.

Employers and primary-care providers have organized around Medicare Advantage beneficiaries and Medicare Shared Savings Plans, but a more integrated model encompassing the rest of the patient population hasn’t materialized, said Dr. Christopher Crow, president of the Catalyst Health Network, which has nearly 1,000 primary care providers across Texas.

“When we saw the failure of fee-for-service during this pandemic, all of a sudden doctors were more interested, as were employers,” said Crow, who helped spearhead the partnership, adding that employers had long been interested in access to quality primary care that’s been proven to lower healthcare costs and boost employees’ health. “The concept of investing upstream in primary care to minimize downstream costs has been there, but we’ve never been able to get the financing model to match a longitudinal care delivery model.”

Medicare Advantage patients were many primary-care providers’ only revenue source for around two months, Crow said, noting that COVID-19 accelerated talks about the coalition, which have taken place over the last couple years. Many primary-care practices are contemplating closing or consolidating as they see expenses rise and fee-for-service revenues plummet.

“Doctors are doing more care than ever, but there aren’t CPT codes for it,” he said, referencing services like coordinating pharmaceutical deliveries and monitoring patients’ chronic diseases.

Around 90% of employers surveyed in April by the Pacific Business Group on Health said that boosting primary care is very important, noting that better primary care may help corral rising healthcare costs. That sentiment has only increased since the pandemic hit, said Anne Ladd, associate director of purchaser innovation at PBGH.

Ladd emphasized the need for more proactive primary care that integrates mental healthcare. The majority of anti-depressants are prescribed through primary-care providers, for instance, but there isn’t the appropriate recognition, incentives nor the infrastructure for that role, she said.

“We really have to fix primary care,” Ladd said. “We have to find a way to incent people to go into medical school to get into primary care, make primary care a more meaningful and rewarding job, and pay better for it so we can address the total cost of care.”


Source: Family doctor, employer groups join forces to replace fee-for-service