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  • Jay Holmes

Primary Care First - Who's In?

We are bracing for another round of primary care payment models to be pushed out next year (2020). The aim is to get more than a quarter of Medicare patients and the same number of providers to enroll. As with any change, we are hearing plenty from those that are for and against.

I feel those against are not against the intention, but more question the true impact of each payment model. In the past, clinics have put in a lot of energy and money, all to have done things well and not get compensated for it. Why is this time any different? This camp wants to sit on the sidelines for a bit to gain confidence before taking more risk. This seems reasonable, but could waiting a year or two leave your clinic too far behind the curve?

Those for these new models cite an easier barrier to entry for smaller clinics as the number of members needed to participate has drastically been reduced. The new models also help address the rigidness of previous models to better serve smaller and more rural clinics. It seems there has been more adjustments to the new models based on industry feedback and insight.

At the end of the day, there are plenty of unknowns. What we do know is that moving to value will take time to figure out, but it certainly is not going anywhere. With all the unknowns, we feel that adoption for these new models will still be relatively low until clinics start seeing a stable payment system that they can count on to offset the risk of moving more of their practice to value based care.

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