Trump administration officials on Monday unveiled an ambitious experiment that seeks to transform Americans’ basic health care and lower costs by offering five new ways to pay primary-care doctors. The initiative is intended to reward doctors for keeping patients healthy and steer them away from Medicare’s fee-for-service system, which experts say can create incentives to provide more care rather than better care.
The new program, called the CMS Primary Cares Initiative, is voluntary, but the administration hopes that one fourth of primary-care providers and a similar share of the 44 million Americans on Medicare will enroll. The program will begin in January 2020.
Health and Human Services Secretary Alex Azar said Monday that the announcement will be remembered as “a historic turning point” for the American health care system.
“This initiative will radically elevate the importance of primary care in American medicine, move toward a system where providers are paid for outcomes rather than procedures, and free doctors to focus on the patients in front of them, rather than the paperwork we send them,” he said.
The new initiative “does not expressly say that Medicare will pay providers for responding to weekend emails or text messages from chronically ill patients, or for doing online or in-home visit to address emergent problems as soon as they arise. But those are the kinds of measures health officials want to encourage primary care doctors to take,” STAT’s Casey Ross writes.
Adam Boehler, director of Medicare’s innovation institute, said that providers participating in the new standard payment model could risk losing 10% of their revenue but also stand to gain as much as 50% depending on their success in keeping patients healthy and out of the hospital.
Why it matters: The Centers for Medicare and Medicaid Services recently projected that spending on medical services will grow 5.5% a year over the next eight years, reaching $6 trillion annually, or nearly 20 percent of GDP, by 2027. “This new initiative is the most sweeping attempt to date to change primary care, an area that accounts for about 3 percent of costs but influences the trajectory of illnesses that account for a much greater percentage of expenses,” STAT’s Ross says.