The Centers for Medicaid and Medicare Services (CMS) released yet another voluntary payment model intended on restructuring financial reimbursement for primary care services. At face value, Primary Care First furthers many of the underlying concepts utilized in CPC+ by generally offering upfront Per-Member-Per-Month (PMPM) payments to providers while theoretically undercutting the financial pressure for primary care physicians to push volume of appointments over meaningful time spent with patients. Primary Care First intends to upend market realities that straightforward Fee-For-Service reimbursement pressures put on providers to drive focus towards patient outcomes.

Just another CMS pilot? Maybe. It’s worth looking into this long stream of programs and initiatives CMS has unveiled aimed at re-prioritizing primary care, to clear up time for patients with complex chronic ailments. This simultaneous effort to increase patient health outcomes and reduce total costs of care may seem like just another theoretic framework doomed, waiting to face harsh practical realities to an untrained eye.  Though this multiprong effort intending to liberate a primary care office from the many inefficient entanglements’ providers face, simply trying to get paid for providing care, there is a more impactful lesson here. So, what makes Primary Care First different than any other lofty so-called “Re-design”? Nothing.

Nothing except for a potentially brand new medical framework to prove your ability to offer effective care coordination that actually reduces readmissions, unnecessary ED utilization, and simply shows your personalized care plans works better for your patients than your competitor down the street. Nothing except for the capability to pivot PMPM success from CMS to your local employer and payors, with data, infrastructure, and legal means to do so. Nothing except for a temporary breath of financial fresh air to contemplate your own practices to see how you can meet patients on their terms, rather than in the terms of a Medicare Fee Schedule. Nothing except another source of profitable information your Clinical Integration Network can bring to the negotiating table. How so?

In order to change our current circumstances, we need to change the conversation. So, how can we change the conversation? Easy, develop something new to talk about, that is worth talking about, and then talk about it, a lot.

Something new to conversate with your local self-insured employer groups may be your recent successes in reducing avoidable admissions amongst your highest acuity patients. Something new to conversate with a large local employer may be your home-grown lower-back pain “clinic” that you integrated into your practice that created a pathway toward therapeutic rather than surgical care, when appropriate.

See a trend here?

Something new to conversate with your regional Medicare Advantage payors may be your successful annual wellness visit in which an NP captures over 80% of your patients on a yearly basis, funneling them to their PCP when necessary with a practical team-based care model. They’d certainly be interested in hearing how you developed a pathway to document HCC coding for 80% of your eligible patients. The thinking is simple, do not undervalue how swiftly you can position recent action into conversation, and bring that conversation to those that need it most. With a bit of disciplined strategic discussion and transparent action, primary care practices are perfectly positioned to dovetail any population health success in quality, clinical outcomes, and financial savings with CMS to interested parties down the street. Those who struggle to see this, will likely continue to face new disrupting competitors showing up unannounced with proven evidence at succeeding in reducing non-value adding health costs by providing technologically-advanced personalized team-based care that patients, employers, and providers all desire.

Need help with your contracting strategy? Click here to learn more about our services.

In mid-November 2018, the CMS, under the direction of the Trump administration, proposed highly anticipated modifications to managed care regulations that were put in place back in 2016. These modifications would grant states more flexibility in determining network adequacy standards for Medicaid managed-care plans, with intentions of aligning Medicaid regulations more closely with Medicare Advantage standards. Simply stated, the intent was to generally increase the privatization of Medicaid Managed Care and limit federal financial involvement.

Given that Medicaid Managed Care Organizations behave similarly to self-insured employer groups, states vary in the levels of financial risk taken when contracting with participating provider networks. This relationship creates a unique opportunity for provider networks to either solidify their network by aligning with other existent contracts, or more realistically, a chaotic scenario involving a misaligned blend of Medicaid, Medicare Advantage, and commercial participation within a provider network, or even individual physician office. This brings the all-too-familiar patient confusion, revenue cycle difficulties, front-office misunderstandings, and overall provider enrollment nightmares.

Of the many aspects of the proposed rule, that will soon be publicized as a final rule, include:

• Pass-Through Payments – This proposal expands states’ authority to direct payments from plans to providers in states transitioning towards Medicaid managed care from traditional Fee-For-Service models. The proposal is a three-year period that permits states to require payments that equate Fee-For-Service reimbursements to ease the financial transition for provider organizations and healthcare facilities.
• Testing Value-based payment reform – This proposal permits increased authority at the state level to offer value-based payment models potentially reflecting value-based methodologies used in Medicare Advantage and commercial markets. It is noteworthy that this does not directly mimic Medicare Advantage frameworks which reduces much-needed value-based synchrony but offers regional flexibility for provider groups to actively negotiate mirroring value-based contracts with a traditionally siloed payor class such as a CMO plan.
• Provider Network Adequacy – Currently, states enforce network adequacy standards that include time and distance standards for various provider specialties. Many argue this deters telehealth and telemedicine capabilities that could allow networks to include distant professionals. This proposal eliminates this requirement completely and replaces it with quantitative network adequacy standards that may include loosely defined provider-to-patient network ratios. Completely removing the time and distance rules for even primary care providers caused significant concern with provider organizations, which is likely to be addressed in the final rule. Additionally, states would now maintain the authority to define “specialists” in terms of network adequacy standards.
• Rate Ranges – The proposed rule allows rate to vary only by beneficiary or service characteristics, unlike the current reliance on the level of Federal Financial Participation (FFP). Importantly, this rule modifies the stipulation that payment modifications must be delivered based on sound actuarial principles. This means any revisions and underpaid reimbursement due to a variety of rate-related issues could be simply denied.
• Coordination of Benefits (COB) – As managed care enrollees are often covered by multiple sources (Dual eligibility in Medicare Advantage, specialized behavior/dental care, etc). Currently, the proposal offers states the flexibility to route claims as they chose rather than the existent policy that leverages Medicare’s claims routing methodology.

Further Information provided by The Centers for Medicare and Medicaid Services can be found here.

In the age where Buzzfeed listicles dominate and memes have replaced words, it’s difficult to figure out how to create blog content that will keep a reader engaged past the title. The good news? We have some tips on how to hook those readers in and keep them coming back for more.

1. The acronyms are actually important.
The digital age is filled with talk of the almighty SEO, or Search Engine Optimization. The lofty air surrounding SEO engagement is actually pretty vital to a blog or really any digital marketing campaign. Keywords lie at the heart of SEO optimization. They’re the main points of your content and will help Google guide potential readers to your site. This is not to say that you need to throw a million keywords in your blog so that the actual points are muddled with Google-nonsense. The reason why someone clicked on your post was because they were interested in the title and/or topic, so make sure you deliver on that promise.

2. Images, Images, Images
Unfortunately, most people won’t stick through text-heavy content. To get people to keep reading, come up with creative subtexts, organize the information into bullet points or lists, provide links to other sources, and include those images and/or videos. In this article by The Guardian, research shows that videos are the way of the future, so partner with YouTube and start cranking out interesting clips to accompany your blog posts.

3. Give your readers something in return.
Sure, the information that you’ll be providing is a gift enough, but sometimes creating even more engaging content means providing the readers with something tangible. Perhaps for a share, your reader can download some cool treat (i.e. white paper, ebook, video) that relates to the blog content? Creating contests will also help boost your fan base. People love to compete, and what better way to get your business out in the virtual sphere than by having people share your information for a prize?

4. Grammar is actually important!
Play with words to make your copy more lively and fun to read. Know when to be direct and when it’s proper to be passive. Depending on your company, some topics should be said in a more approachable manner with suggestions rather than rules. As we’ve been doing, use the second person to talk directly to the reader. Yes…you! Keep your tone of voice in mind when creating content as well. Nothing will put a reader off more than an unfriendly or rude tone.

5. Literally engage your readers.
Listen to what your audience is saying about a particular product/trend/whatever your business does, then try to get them to respond on your blog. Ask questions. Be inviting. Encourage comments.

6. And your point is?
Throwing out lots of jokes and using fancy jargon may be great for some circles, but when it comes to getting people to engage with your content, stick with what appeals to a broader population. If your witty title talks about how to create engaging content, for instance, than what follows that heading should be all about that topic. (Are we doing okay?) It’s also a good idea to follow current trends. Entrepreneur says it best, “Specific triggers get more people to share our content, spreading our message, gaining traction, winning customers and beating the competition.”

Written by Jeremy Miller with Boost by Design.