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Maryland’s Primary Care Program: incremental progress or breakthrough?

Much has changed in the past six years since our last-place Health Policy Journal Club at Georgetown. Our residency, formerly a collaboration with Providence Hospital, is now known as the Medstar Health/ Georgetown-Washington Hospital Center Family Medicine Residency Program. I stepped down as conductor of the Robert L. Phillips, Jr. Health Policy Fellowship 3 years ago, though I still experience wielding alongside these talented attending physician in clinic, such as Dr. Brian Antono, who recently blogged about his fellowship events for Harvard Medical School’s Center for Primary health care. And this academic year I am not only wreaking remotely due to COVID-1 9, I am more than 2,000 miles off campus as a visiting prof at the University of Utah in Salt Lake City.

What hasn’t altered is that our family medicine citizens remain agitated about health programme and advocacy. Since their continuity clinic continues to be located in Maryland, we decided that a great topic to revive this sequence of meetings was the Maryland Primary health care Program( MDPCP ), which was recently featured in a Milbank Memorial Fund Issue Brief.

MDPCP is a multi-payer “advanced primary care” program modeled after previous patient-centered medical residence programmes such as the Center for Medicare and Medicaid Innovation’s( CMMI) Comprehensive Primary Care initiative. CMMI partnered with Maryland’s Department of Health to propel MDPCP last year with Medicare as the first participating payer.( CareFirst Blue Cross Blue Shield joined the program in 2020.) With 476 participating primary health care practices, MDPCP affords prospective , non-visit located fees known as “care management fees” and operational reinforcement from a program management office and Care Transformation Organizations( CTO ). According to MedChi, the average practice received $176,000 in care management fees in 2019.

Interestingly, Medstar not only participates through its structure of Medstar Medical Group rules, but is also a CTO serving Medstar and non-Medstar rehearses throughout the state. MDPCP practises must implement “data-driven, risk-stratified care management, ” integrate behavioral health services, screen patients for social needs, gather a patient advisory council, and use health information technology for continuous quality improvement.

We spent some time discussing one unique position of MDPCP, a tool to reduce avoidable health services developed by the University of Maryland’s Hilltop Institute. This electronic implement applies neural networks to sieve through patients’ demographics, claims, and other data to produce a list of those with the greatest likelihood of an emergency department visit or hospitalization, theoretically allowing primary health care specialists to intervene to prevent the event and its accompanied medical expenses. Nonetheless, it wasn’t clear to us how easy it would be to apply this information, given that we typically need to prioritize patients on the schedule for that day.

Another feature of the program allows MDPCP rehearsals to identify “high-volume, high-cost specialists” in order to “focus attention on the relative overheads between consultants and to have providers participate experts of speeches and cooperation agreements about creating value.” First, though it may be helpful to know which subspecialists are more likely to prescribe( perhaps improper) expensive assessments or procedures, the tool does not measure excellence in other areas, such as patient satisfaction and tone of communication with primary care specialists. Likewise, patients may not have a choice of experts, depending on the insurer’s network. Finally, it seems awkward and unrealistic for a family doctor to tell a specialist that his or her practice vogue is too aggressive, even if there’s good data to back it up.

MDPCP promises to narrow the primary care-subspecialist reimbursement gap and provide opportunities to improve patient care in the short term. However, expecting primary care traditions to deform the health care cost veer on their own, even with additional funding and assistance, may miscarry in the long run. Whether MDPCP represents incremental progress in primary care, or a genuine breakthrough, remains to be seen.

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This post first appeared on The Health Policy Exchange.

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