The Future of Healthcare is Here: CMS Launches Largest-Ever Multi-Payer Initiative

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The US government did something monumental today. As an extension to the Affordable Care Act, they have put into place a new initiative that enables our doctors and health care teams to have the freedom to administer care in a way they think will deliver the best outcomes to you and me!

You ask why our doctors might not have given us the care they thought we needed in the past?

The economic system didn’t reward it.

For example, if you got put on a new drug, say insulin if you have diabetes, your doctor didn’t get paid to help you manage that drug and stay on it when you left their office. There was no monetary incentive in place to help you stabilize your diabetes on this new drug at home. They did get paid for your visit and even for a follow-up visit, but a call or a remote interaction to help you give yourself shots or to answer questions about things that might not have been covered or that you thought of when you left the office was just not covered, until today. As a result, some clinicians did the “in between” support, but most just didn’t.

Today, the Centers for Medicare & Medicaid Services (CMS) launched the largest ever multi-payer initiative to enable clinical teams to do what they think is necessary to help their patients stay healthy! They are calling it the CPC+ “Comprehensive Primary Care Plus” model. The initiative starts with a subsegment of the US population. It is being implemented in up to 20 regions in the US, can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve.

Essentially, this new initiative built on the Comprehensive Primary Care Initiative developed in 2012, benefits you and me because it reimburses primary care practices for:

  • Supporting patients with serious or chronic diseases to achieve their health goals
  • Giving patients 24-hour access to care and health information
  • Delivering preventive care (think Mobile Health, Remote Monitoring and Telemedicine)
  • Engaging patients and their families in their own care (Mobile apps that allow you to monitor yourself and share it via the cloud to family members will be big here!)
  • Working together with hospitals and other clinicians, including specialists, to provide better coordinated care (cool! This plays off of a white paper we published about Chronic Care Management)

Wow – these are things I know I would love to get from my PCP. The ability to access care, get questions answered and get support when taking a medication, all remotely so I don’t have to miss work for a doctor’s appointment will change my life and the lives of many of us!

Here’s my favorite quote on this from the CMS deputy director:

“By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our healthcare dollars,” said Dr. Patrick Conway, CMS deputy administrator and chief medical officer.

The potential for this is huge for not only the health system (they get paid!), the doctors (they get to give the care they want and get paid!), but for you and me.

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