On April 18, 2022, PCC submitted a letter to CMS regarding a request for information on access to care and coverage for people enrolled in Medicaid and CHIP.

The Primary Care Collaborative (PCC) appreciates this opportunity to provide comments in response to CMS’s Request for Information on Access to Care and Coverage for People Enrolled in Medicaid and CHIP. PCC applauds CMS for pursuing Medicaid and CHIP rulemaking to enhance coverage, expand access to care, and improve availability and quality of primary care practices and health care providers.

PCC provides detailed responses to the specific questions included in the RFI. To summarize, PCC recommends that CMS:

• Prioritize adoption of twelve-month continuous coverage for Medicaid and CHIP beneficiaries and to limit eligibility redeterminations;
• Consider access to and investment in primary care in development of any future minimum standards;
• Promote evidence-based models of primary care-behavioral health integration;
• Issue comprehensive guidance to states on payment for evidence-based community health worker services;
• Work with states to remove reimbursement barriers to the delivery of telemental health services to Medicaid beneficiaries by primary care practices; and
• Require higher-quality data collection and reporting from states regarding race/ethnicity data and other demographic data.

If the U.S. wants to give everyone access to healthcare, fee-for-service medicine has to go, Donald Berwick, MD, former president of the Institute for Healthcare Improvement, said at a webinar on value-based care sponsored by the Duke Margolis Center for Health Policy.

“We should move to global budgets as soon as possible,” Berwick said at Thursday’s event. “It will not happen in a fee-for-service environment; I just don’t believe it can. And so the more we get to funding organizations to give total care to populations, the better.”

Primary care payment models out of the Center for Medicare and Medicaid Innovation have seen a number of updates in recent weeks. Practices that joined the Comprehensive Primary Care Plus (CPC+) model in 2018 recently learned that their fifth year of the model (anticipated for 2022) would be canceled. The CPC+ program will now end for all practices on December 31, 2021.

Separately, application deadlines for the Primary Care First model were extended: Practices interested in joining Cohort 2 should apply by May 21; payers have until June 18. While CMMI announced the 53 organizations participating in the Global and Professional Direct Contracting Model s first performance year (which began April 1), it also announced that it would not be opening applications for 2022 as originally planned. Previously, the Geographic Direct Contracting model had also been put on hold while under review.

In its broadest look yet at primary care spending, the PCC analyzes spending over time, nationally and in all 50 states, in this year’s research report. The report reveals some alarming trends.

Evidence Report Briefing

This video is a recording of Ann Kempski, lead author of the report, presenting its findings at the report’s release, which took place on December 2, 2020, as part of a PCC workshop on primary care investment at the state level.

2020 Evidence Report

Primary Care Spending: High Stakes, Low Investment is the PCC’s annual research report for 2020. It shows that the U.S. health system’s investment in primary care, as measured by primary care spending, is low and declined between 2017 and 2019, both nationally and in a majority of states. The findings support a growing body of literature showing that health systems with a foundation of robust, comprehensive primary care achieve better, more equitable health outcomes and are less costly.

Executive Summary

The Executive Summary provides an overview of the 2020 PCC Evidence Report. This concise version summarizes the qualitative and quantitative findings.

Sponsors

Thank you to our sponsors.

In its broadest look yet at primary care spending, the PCC analyzes spending over time, nationally and in all 50 states, in this year’s research report. The report reveals some alarming trends.

Evidence Report Briefing

This video is a recording of Ann Kempski, lead author of the report, presenting its findings at the report’s release, which took place on December 2, 2020, as part of a PCC workshop on primary care investment at the state level.

Download the 2020 Evidence Report

Primary Care Spending: High Stakes, Low Investment is the PCC’s annual research report for 2020. It shows that the U.S. health system’s investment in primary care, as measured by primary care spending, is low and declined between 2017 and 2019, both nationally and in a majority of states. The findings support a growing body of literature showing that health systems with a foundation of robust, comprehensive primary care achieve better, more equitable health outcomes and are less costly.

2019 Evidence Report

View the 2019 evidence report that the 2020 report is built on.

News Release

View our press release for this report: “PCC’s New Report Sounds Alarm on Low and Declining U.S. Primary Care Spending” from 12/03/2020.

Sponsors

The Primary Care Collaborative thanks the following PCC board of directors’ organizations for their generosity. Their support made the 2020 Evidence Report possible.

In a first-of-its-kind study, this year’s report examines states primary care spending patterns, including spending across payer types, and considers the implications of these results for select patient outcomes.

Evidence Report Briefing

Download the 2019 Evidence Report

The PCPCC 2019 Executive Report provides quantitative data and analysis of primary care spend at the state and payer levels, as well as a window into the association between primary care spend and key patient outcomes. In short, the report shows that primary care investment as a percentage of total health care expenditures was low between 2011 and 2016, and it varied considerably across states and across payers. The analysis also shows an association between more primary care investment and better patient outcomes. Finally, the report includes a description of legislative/regulatory efforts in 10 states to measure and report on primary care spend and to shift more resources into primary care.

Primary care is a small slice of health spending overall, but it has a significant impact on downstream costs and quality.

– Alex M. Azar II, Secretary of HHS

Washington, DC—April 23, 2019 The Patient-Centered Primary Care Collaborative (PCPCC) applauds CMS for its new Primary Cares Initiative, an innovative approach to Medicare payment models that reinforces the centrality of primary care to achieve better patient health and value.

The announcement yesterday by HHS Secretary Alex Azar, CMS Administrator Seema Verma, and CMMI Director Adam Boehler occurred after an unprecedented, invitation-only meeting that PCPCC participated in and builds on recent conversations PCPCC has had with CMMI about how to achieve the critical goals of enhancing the health of our nation by investing more resources in advanced primary care delivery models.

“We were pleased to participate in the development of these significant new Medicare payment models, and commend top HHS leaders for focusing on the centrality of primary care to achieve enhanced patient value,” said Ann Greiner, PCPCC President and CEO. “This is a major step in the right direction by the nation s largest payer, one that promises to transform the role primary care plays in our national healthcare system.”

There are two basic models in the Primary Cares Initiative which targets beneficiaries in traditional Medicare Primary Care First (a new track within CPC+) and Direct Contracting and both contain separate tracks for patients with multiple complex chronic conditions or acute illnesses who are not receiving well-coordinated care.

PCPCC looks forward to continuing to work with HHS leaders on achieving additional goals

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The Patient-Centered Primary Care Collaborative
Founded in 2006, the Patient-Centered Primary Care Collaborative (PCPCC) is a not-for-profit multi-stakeholder membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. Representing a broad group of public and private organizations, PCPCC s mission is to unify and engage diverse stakeholders in promoting policies and sharing best practices that support growth of high-performing primary care and achieve the Quadruple Aim : better care, better health, lower costs, and greater joy for clinicians and staff in delivery of care.

PCPCC is and will position itself as an advocacy organization a coalition that serves as a driver of change, educating and advocating for ideas, concepts, policies, and programs that advance the goals of high-performing primary care as the foundation of our health care system. For more information about PCPCC, visit www.pcpcc.org.

MEDIA CONTACT
Arlyn Riskind, ariskind@pcpcc.org; 202-431-9495

Additional Resources:

Press release: HHS NEWS: HHS To Deliver Value-Based Transformation in Primary Care

CMS Primary Cares Initiative Fact Sheet

Primary Care First Payment Model

Primary Care First Fact Sheet

Direct Contracting Payment Model

Direct Contracting Fact Sheet

Direct Contracting Geographic Request for Information

In the first-ever study of its kind, the Patient-Centered Primary Care Collaborative’s (PCPCC) 2018 Evidence Report examines the interaction between the Patient-Centered Medical Homes (PCMHs) and the Accountable Care Organization (ACOs) through both qualitative and quantitative methods.

Download the 2018 Evidence Report

The PCPCC 2018 Executive Report examines how the role of advanced primary care, such as the PCMH, may contribute to the success or failure of ACOs. To answer this question, the researchers at the Robert Graham Center and IBM Watson Health utilized qualitative and quantitative methods. The qualitative methods included two literature reviews and the input of an expert committee. The quantative research included analysis of the 2014 Medicare Shared Savings Program (MSSP) data set and NCQA PCMH data set.

Executive Summary

The Executive Summary provides an overview of the 2018 PCPCC Executive Report. This concise version summarizes the qualitative and quantitative findings.

Key Findings – White Paper

The White Paper summarizes the topline results of the 2018 PCPCC Executive Report. In addition, the White Paper describes the importance of this research.

The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization reviews PCMH results from 45 peer-reviewed reports and additional government and state evaluations. Implementation of the PCMH and high performing primary care differs depending upon the needs and preferences of those delivering, receiving, and paying for related care.

The sixth annual PCPCC report, authored by the Robert Graham Center of the American Academy of Family Physicians and published with support from the Milbank Memorial Fund, employed broader search terms and more rigorous search criteria that evaluated studies, reports, and evaluations published between November 1, 2015 to February 28, 2017. It also features examples and data from PCMH programs, such as Blue Cross Blue Shield of Michigan, which leads one of the oldest PCMH programs, now in its eighth year with seven years of data; the Comprehensive Primary Care Initiative launched by the Center for Medicare and Medicaid Innovation; and state primary care initiatives including Colorado, Minnesota, and Oregon.