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Oregon Medical Practices Join Fledgling ACA-backed Medicare Effort

As US Congress debates dismantling the Affordable Care Act, an program that seeks to strengthen primary care and lower healthcare costs gets under way
January 13, 2017

A nationwide effort to strengthen primary care, lower healthcare spending and improve the lives of Medicare patients launched in Oregon this month -- just as Republicans in the U.S. Congress vow to gut the Affordable Care Act, which created this fledgling program.

Dubbed CPC+, for Comprehensive Primary Care Plus, the program’s ultimate goal is to base medical care around primary care providers, in the hope that better coordination will reduce costs and improve health. CPC+ seeks to nudge medical practices by changing how physicians are paid – rewarding those who get better results.

CPC+ sets up two different tracks for primary care practices: high-volume, low-cost practices, which see generally healthier patients; and practices that see fewer patients whose needs are more complex.

“Care delivery redesign ensures practices in each track have the infrastructure to deliver better care to result in a healthier patient population,” according to a Centers for Medicare & Medicaid Services briefing on CPC+

It’s an approach some health insurance companies and Medicaid-based coordinated care organizations have also touted, and some have attempted to negotiate new payment approaches with clinicians.

But 44 million people – some 15 percent of the U.S. population – are enrolled in Medicare, according to AARP. That gives CPC+ clout.

“My experience in health law is that, as goes Medicare, so goes the nation,” said attorney Bruce Howell, partner at Schwabe Williamson & Wyatt, and leader of the firm’s Healthcare Industry Group.

The program’s first stage is geographically limited, and includes Oregon as one of 14 states or regions. California and Washington are not on the list. Medical practices had to apply last year, and the program launched at the start of 2017. CMS expected to cap enlistment at about 5,000 practices, an estimated 20,000 medical providers and up to 25 million patients affected by CPC+.

“The OMA is pleased and excited that Oregon is being given the opportunity to provide leadership in the program rollout,” said Aaron Ragan-Fore, director of marketing and communications at the Oregon Medical Association.

Healthcare leaders in the state pushed hard to be included in the first rollout of this new program, said Joy Conklin, vice president of practice advocacy at the OMA.

“Starting in August, there was movement by many organizations in Oregon, including the Oregon Health Authority, who strongly recommended that all eligible providers across the state apply to participate in CPC +” Conklin told The Lund Report in an email.

In a briefing released in August, the Oregon Health Authority said that the CPC+ program aligns Medicare with Medicaid and private insurance payment models – and “continues to move the

healthcare system away from a rigid, fee-for service environment to a model that supports clinicians delivering the care that best meets the needs of their patients.”

Details about how many Oregon practices are participating are not yet available.

But those practices had to weigh a number of considerations when deciding whether to enroll, Conklin said.

In addition to the financial considerations – looking at how changes to payment would affect a practice’s bottom line – clinicians also had to consider their relationships with participating payors, she said. “They also need to make sure they have the right staff with the skills to be able to collect the information. And finally, their technology needs to be up to speed.”

According to CMS, these CCOs and insurance companies all offer Medicare plans and are participating in CPC+ in Oregon: AllCare, ATRIO, CareOregon, Eastern Oregon CCO, FamilyCare Health, Moda Health Plan, PacificSource, Primary Health of Josephine County, Providence Health, Tuality Health, Umpq Health, Western Oregon Advanced Health, Willamette Valley Community Health, Yamhill Community Care Organization.

It’s not lost on anyone that CPC+, which is slated to run for an initial five years and which was designed after a four-year pilot, is being launched at a time when the future of the Affordable Care Act is very much in doubt.

“There is much uncertainty in healthcare at this juncture as the payment methodologies shift away from fee-for-service to more value based,” the OMA’s Conklin said on Thursday. “The addition of the possibility of the repeal of the ACA adds to the uncertainty.”

In an interview last week, before Congress and the Senate began preliminary votes to dismantle aspects of the Affordable Care Act, attorney Howell expressed hope that CPC+, or something similar, might survive, even if the ACA is cut.

“Who knows what is going to happen?” he said. “In some way shape or form, I think this might continue. The Affordable Care Act came in and laid down the foundation, then CMS came out with its rules, these went final at the end of last year. This program is off and running not withstanding all the braggadocio around the future of this system, there’s a lot that has been put in that will still be there.”

-- Courtney Sherwood can be reached at [email protected], or follow her on Twitter at @csherwood.