In the News: May 2–9

CMS Announces Its Primary Cares Initiative

A recent Health Affairs article highlights CMS’s newly announced value-based care models for primary care, the Primary Cares Initiative (PCI). PCI is composed of 5 voluntary, risk-sharing models built to foster better patient outcomes and spur innovation.

The 5 models are split into Primary Care First (PCF) and Direct Contracting (DC) paths. The 2 PCF models are geared toward practices advanced enough to take on more risk in primary care, with one model offering population-based payments with flat primary care visit fees, while the other is for seriously-ill populations (SIPs), resulting in a more specialized payment structure.

The DC pathway presents 3 models catering to mainly larger health care entities (ie, accountable care organizations): Professional, Global and Geographic. The Professional model offers the least risk at 50% with “Primary Care Capitation” payment, meaning monthly, risk-adjusted capitation payments for “enhanced primary care services.” The Global model will allow entities to take on 100% risk with a choice between the “Primary Care Capitation” payment structure or a “Total Care Capitation” payment system, which is a monthly, risk-adjusted payment for all services taking place in a patient’s care. The Geographic model is the most complex and is still being finalized, with CMS asking for feedback on design parameters.

These new primary care risk-sharing models are CMS’s newest steps toward value-based care. The on-demand Sg2 webinar Value-Based Care Structure can provide insights into different organizational structures for designing and scaling the components and initiatives of value-based care, as well as programs to succeed in the transition from fee-for-service.

Medically Tailored Meal Programs Impact Acute Care Usage

A recent JAMA Internal Medicine study used 2011–2015 data from the Massachusetts all-payer claims database and Community Servings, a not-for-profit organization that delivers MTMs, to examine the association between participation in medically tailored meal (MTM) programs and acute care utilization for medically and socially complex adults. The study found adults receiving 10 MTMs each week (under the supervision of a registered dietician nutritionist) had significantly fewer inpatient admissions than those who did not, and the receipt of MTMs was associated with fewer skilled nursing facility admissions. Their models estimate that mean monthly costs would have been 20% lower had the entire cohort received the intervention, suggesting that MTMs may be an effective strategy to address food insecurity and lower acute care utilization in medically and socially complex adults.

While the association between social determinants of health (SDOH) and health outcomes is well established, when and how to best intervene across different populations is yet to be determined. While many hospital and health system programs addressing SDOH are nascent, Sg2 believes as the health care landscape continues to shift toward value-based care, providers will be further enabled to expand these types of programs. To learn more about how hospitals and health systems have addressed SDOH, please read the Sg2 FAQ Social Determinants of Health: Taking Action Beyond the System of Care.

Precision Medicine Techniques Identify Rare Genetic Diseases

A recent ScienceDaily article describes how scientists at UT Southwestern Children’s Medical Center Research Institute are combining DNA sequencing and chemical analysis called metabolomics to increase the speed in which defective genes are identified in patients on an individual basis. Ultimately, this new approach allows scientists to determine the exact causes of rare genetic diseases in children and identify treatment options faster and more accurately than traditional methods would otherwise allow.

Currently, genetic based diseases account for a significant portion of illnesses and deaths in children and result in approximately 25% of pediatric hospital admissions. Many of these genetic diseases are caused by inborn metabolism errors that can be treated through dietary modifications if caught early, but many children are diagnosed with the disease after becoming ill. Due to the rarity of these diseases, a diagnosis may take months or years and sometimes involves invasive procedures; however, with advancements in precision medicine, there is the potential to pinpoint the exact defective gene much faster and intervene earlier.

Precision medicine is continuing to grow, allowing advances in medicine to be successful in fewer attempts. To read more on how precision medicine is trending across health systems and how it is expected to impact future financial forecasts, please watch the on-demand Sg2 webinar Precision Medicine: Cut Costs With Anticipatory Care Redesign.

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