August 31 was the deadline for physician practices to apply for the Maryland Primary Care Program. The tally of applicants for the first year – nearly 600 representing several thousand physicians – far exceeded projections. Ultimate participation may be smaller as CMMI wants to be sure each practice has enough patients on its panel to let the “law of large numbers” work.
The enthusiasm is encouraging and suggests that care transformation is of interest to more than just hospitals. That’s important, given that hospitals’ success under the Total Cost of Care Model, where we are the only at-risk actors, depends on big changes in the way non-hospital providers deliver care.
The primary care program has five core elements to drive change in physician practice: care management, access and continuity, planned care for health outcomes, beneficiary and caregiver experience, and comprehensiveness and coordination across the continuum of care.
These sound similar to a lot of the buzzwords that apply to the ways our hospitals are working to drive cost containment while preserving or improving the quality of care. And in fact, most of the Care Transformation Organizations that were selected to support the primary care practices are hospital affiliates.
So, yes, we do hope the primary care program succeeds.
But the program warrants close monitoring, as its potential return on investment is not assured. The care management costs associated with the program will be counted against the total cost of care beginning January 1, 2019, so savings must be accelerated elsewhere to offset the spending.
For some perspective, in year four of the current model (2017), non-hospital spending exceeded the national trend by $147 million. Hospital savings of $285 million more than offset this excess, but there is precious little room for hospitals to offset deficits on the non-hospital side of the ledger.
The primary care program is one of several tools being established to help doctors, post-acute care providers and others to act more like hospitals have been under global budgets – focusing on efficient, effective care. In this environment, where many strategies are being launched statewide, it’s important that hospitals connect with care partners across the continuum to ensure the model’s success.
We at your MHA will also engage with our counterparts in the private and public sectors to ease implementation, assess program performance, and press for improvements where warranted.