PCC 2019 Winter Newsletter


December 2019


Message from Ann Greiner


Annual Conference Recap

At the start of the conference, our President & CEO Ann Greiner announced our new brand identity and name! The PCPCC is pleased to now be the Primary Care Collaborative (PCC), with the tagline: Convening + Uniting + Transforming. Not losing our dedication and commitment to person- and family-centered care, PCC's new logo keeps the patient at the center of everything we do.

On Sunday, November 3, PCC hosted the fifth meeting of the International Faculty Collective for the Advancement of Primary Care which brought together a collective of international leaders in health care to establish evidence, share experiences and best practices, and identify opportunities for collaboration to transform the delivery of, and investment in accountable, integrated primary care. 

For the first time, PCC hosted a pre-conference tech event Digital Disruption: Activating Primary Care. The event’s keynote presentation from James Weinstein, Senior Vice President for Microsoft Health Care, examined how technology can support the Shared Principles of Primary Care
The conference began with Eric Topol, MD, Executive VP, Scripps Research giving a provocative talk that considered how technology, particularly AI, is posed to change the care experience for patients and clinicians alike. Later in the program, Amy Bassano, Acting Director, Center for Medicare and Medicaid Innovation (CMMI) provided a timely policy update about the Center’s efforts to reform primary care delivery and payment.  Richard Baron, MD, who led the development of the first CMMI primary care models and now leads ABIM and ABIM Foundation, interviewed Amy about the new Primary Cares models. Attendees were then invited to collaborate with one another and discuss benefits and concerns regarding these new models, which PCC collected and later synthesized and reported back to CMMI staff.

That evening, PCC hosted the Barbara Starfield Awards Dinner and Program to celebrate primary care champions. Awardees included:
  • Christopher Koller, President, Milbank Memorial Fund, who received the prestigious Barbara Starfield Primary Care Leadership Award; 
  • The Primary Care Development Corporation (PCDC), who received the Advanced Primary Care Practice Award; and
  • Matt Probst, PA-C, Chris Ruge, FNP, and Leslie Hayes, MD of El Centro Family Health, who received the Primary Care Community Leadership Award
Asaf Bitton, MD, MPH, Executive Director of Ariadne Labs, closed out the conference with a keynote address on what lies ahead for primary care, its strengths and challenges, as well as the role of advocates in creating a better, more empowered primary care system for the future.

Immediately following the conference, Executive Members were invited to join a workshop to discuss and learn more about emerging models and metrics to advance high-value care.

Welcome New Executive Members

The PCC would like to welcome one organization as the newest addition to the Executive Membership.
We are happy to announce this addition to the Executive Membership and are excited for the engagement and advocacy they will bring to the Collaborative.

Policy & Advocacy Update

State-level primary care investment work continues—Movement continues at the state level as more states continue to pursue efforts to report and target levels of primary care investment. 
  • This month, Washington state transmitted its Primary Care Expenditure Study Report to the state legislature. Primary care expenditures ranged from 4.4% (narrow definition) to 5.6% (broad definition) of total medical expenditures, with percentages largely consistent across  public employee, Medicaid, and commercial coverage. 
  • PCC convened its quarterly call of the Primary Care Investment workgroup with over 60 individuals joining the discussion in November. Topics included: the MA Primary Care Investment Working Group’s list of 16 ideas for investment; an update from the New England States Consortium Systems Organization on their steps to create a standardized primary care report; and Milbank’s contracted work with RAND to develop non-fee-for-service claims specifications to enhance primary care spend measures. 
  • Primary care investment was also featured throughout PCC’s annual conference, including a panel on primary care state investment featuring updates from VT, CO, and RI, as well as a breakfast with individuals involved in state-level policy efforts to discuss their successes and challenges. A longer in-person meeting on the topic of primary care investment is being planned for next year’s PCC conference.
  • HCCI Study Shows Stagnant Primary Care Investment—Even as PCC continues to advocate for increased investment in primary care—and an increasing number of states pursue it—this remains a pressing issue. A new study from the Health Care Cost Institute shows slightly declining rates of primary care spending as a share of total spending. The research letter, published December 10th in JAMA, analyzed employer-sponsored insurance data from three national payers, finding that share of total spending attributed to primary care declined between 2013 and 2017 using either a broad definition (from 8.97% to 8.04%) or narrow definition (from 4.60% to 4.35%). Though minimal declines, both were statistically significant. The study found that utilization of primary care clinicians increased over the same period.

CMS Direct Contracting RFA released—At the end of November, CMS released its Request for Applications (RFA) for the Direct Contracting Global and Professional Risk models. The models offer practices the opportunity to participate in an advanced accountable care model, with 50% risk sharing (Professional) or 100% risk sharing (Global). A third model, Geographic, will be released soon. The models offer two payment options: either a primary care capitation (7% of Part A & B) or total care capitation (100%). The 5-year performance periods begin 2021 with an optional implementation period in 2020. Applications to participate in the implementation period are due February 25, 2020, open to any entity that already submitted a non-binding letter of intent. Visit CMS’s webpage to learn more about eligible direct contracting entities, beneficiary thresholds, financial incentives and more.

Final Physician Fee Schedule released—The final 2020 Medicare Physician Fee Schedule was released November 1. The rule provides welcome increases to office/outpatient E/M values for primary care and non-procedural specialty care and allows clinicians to choose the E/M visit level based on either medical decision making or time. Other positive additions include: a new Medicare Part B benefit for OUD treatment services; reduction in EHR documentation burden; and more flexible supervision requirements for PAs. 
Primary Care Support in Senate LHSS Appropriations Report—Earlier this fall, the Senate Labor-HHS Appropriations Report was issued; the report states the Committee’s support for “primary care clinical research and dissemination as a core function AHRQ”. It also recommends $2,000,000 to support a study of state primary care demonstrations to learn from “states that have taken action aimed at improving the delivery of primary care.” Stay tuned to learn more as federal spending negotiations continue.


PCORI Update

Over the last year, PCC has been conducting a PCORI-funded examination of its dissemination methods using the study Use of Patient Portals by People with Long-Term Health Problems as a pilot. A PCC-convened Advisory Council has helped to inform the work by providing diverse perspectives and giving insights into how to best reach different stakeholder groups.  
If you or any of your colleagues are interested in learning more about our PCORI project or about other research related to primary care, sign up for our quarterly research newsletter: “Focus on Research: Findings Related to Advancing Primary Care."  This newsletter aims to bring together new research findings with implications for diverse stakeholders in the primary care community. 

Now that our pilot study is coming to a close, we are doing an assessment of the efficacy of the various methods we have used over the past months to disseminate these research results. If you have been aware of or engaged with any of this work, please take a moment and fill out the 2-3 minute survey below.
Take the Survey!

PCC Webinars

Most Recent Webinars: 

Webinar: Integrating Primary and Pharmacy Care: What Works for Patients?

On Tuesday, December 17, 2019, PCC hosted the webinar: Integrating Primary and Pharmacy Care: What Works for Patients? Attendees learned about how to successfully manage and optimize patient medications in the context of primary care. Topics covered strategies for successful comprehensive medication management, innovations in pharmacy and primary care integration, and a proposed national action plan for addressing the harms of medication overload.  

Speakers included:
  • Maria S. Kobylinski, Provider, Geisinger Health
  • Heather Schultz, Pharmacy Benefit Manager, IngenioRx
  • Shannon Brownlee, Policy Thought Leader, Lown Institute
  • Julie Schilz, Senior Director, Mathematica

Webinar: Innovations in Caring for Persons with Alzheimer’s and Related Dementias
On Friday, October 25, 2019, PCC hosted the webinar: Innovations in Caring for Persons with Alzheimer’s and Related Dementias. Attendees heard from three organizations and their efforts to provide comprehensive, coordinated, patient-centered care for patients with Alzheimer’s disease and other dementias.
Speakers included:
  • Carolyn Clevenger, RN, DNP, Clinical Director and Nurse Practitioner, Integrated Memory Care Clinic, Emory University
  • David B. Reuben, MD, Director, Multicampus Program in Geriatrics Medicine and Gerontology, University of California, Los Angeles
  • Morgan Daven, MA, Senior Director for Health Systems, Alzheimer's Association
  • Robert Dribbon, Strategy and Innovation, Merck, and Executive Committee Liaison to the Board of Directors of the Patient-Centered Primary Care Collaborative
Upcoming Webinar
Stay tuned for details on PCC’s January webinar on trust and health equity!

Watch Past Webinars

Event Highlights

Findings from Annual 50-State Medicaid Budget Survey

On Friday, October 18, the Kaiser Family Foundation hosted the event A View from the States: Key Medicaid Policy Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020 immediately following the release of their 19th annual 50-state Medicaid budget survey. The briefing was held in collaboration with the National Association of Medicaid Directors (NAMD) and discussed trends in enrollment and spending. Topics included: state waivers with implications for eligibility, expanding community based long-term care, addressing the opioid epidemic, and addressing the social drivers of health.

2019 Signature Series: Solving for Health | Navigating the Frontiers of Innovation and Value Summit

On Wednesday, November 6, the Alliance for Health Policy hosted the event 2019 Signature Series: Solving for Health | Navigating the Frontiers of Innovation and Value Summit. Keynote speakers and panel experts explored the latest advancements and the remaining challenges in the health care value and innovation space, as well as policy solutions to support groundbreaking initiatives. Attendees heard about topics including the value of patient voices, biases and blind spots in innovation, leveraging innovation to drive value, and future policy considerations.

Consumer & Community Leadership: The Key to Better Health

On Wednesday, November 20, Community Catalyst's Center for Consumer Engagement in Health Innovation hosted the event Consumer & Community Leadership: The Key to Better Health, during which attendees heard results from consumer focus groups that were conducted to assess the consumer perspective on primary care's role in addressing complex health and social needs. A panel discussion followed focused on opportunities and challenges to address social needs through health care. The 2019 Speak Up for Better Health Award winner was also presented.

Combating Chronic Conditions

On Tuesday, December 3, POLITICO hosted the event Combating Chronic Conditions presented by the BlueCross BlueShield Association and the American Academy of Family Physicians. The event began with a sponsored segment hosted by BCBS Association, followed by a POLITICO editorial panel moderated by Joanne Kenen, Executive Editor of Health Care. Panelists engaged in a deep-dive conversation to explore policies, strategies, and innovations that could improve primary care treatment for patients with chronic conditions. Key topics included: the challenges of interoperability, changing incentives to reward prevention, the importance of team-based care with the primary care physician as the leader, the connection between homelessness and chronic conditions, and the problems with co-morbid mental/behavioral health conditions and chronic illnesses.

Advancing Comprehensive Primary Care in Medicaid

On Monday, December 9, 2019, the Bipartisan Policy Center hosted the event Advancing Comprehensive Primary Care in Medicaid, during which attendees heard about growing evidence demonstrating the links between primary care investment and higher quality care, better outcomes, and lower costs. Due to the barriers faced by the Medicaid population, it is especially critical to ensure they have access to high-quality, comprehensive primary care.

Commonwealth Fund International Health Policy Survey Briefing

On Wednesday, December 11, 2019Health Affairs hosted the briefing on the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians in 11 Countries. Senior government officials, delivery system experts, and leading policy thinkers—including PCC’s own President & CEO, Ann Greiner—gathered for a high-level discussion of strategies to promote high-quality primary care. The Fund surveyed over 13,000 primary care providers across 11 high-income countries and found a range of results. While the U.S. excelled in some areas, such as virtual communication with patients and access to patient portals, in most areas the country lagged behind its international counterparts including in conducting home visits, coordinating care with other doctors, and managing referrals to social care. Compared to other countries, the US spends a highly disproportionate amount on medical care versus social care. Investing in social care could be a key element to improving health outcomes while reducing total cost of care in the US.

Don't Miss These Articles & Research

Exploring The Relationship Between Social And Medical Service Spending
Health Affairs Blog | October 15, 2019

A View from the States: Key Medicaid Policy Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020
Kaiser Family Foundation | October 18, 2019

Spread of ACOs And Value-Based Payment Models In 2019: Gauging the Impact of Pathways to Success
Health Affairs Blog | October 21, 2019

PCC Press Release | November 4, 2019

Bridging The Gap In Rural Health Access
Health Affairs Blog | November 7, 2019

CMS wants primary-care docs to take on financial risk
Modern Healthcare | November 25, 2019

A Roadmap To Welcoming Health Care Innovation
Health Affairs Blog | November 26, 2019

Addressing Health Disparities in Medicare
Better Medicare Alliance | December 2019

International Survey: Primary Care Physicians in U.S. Struggle More to Coordinate Care and Communicate with Other Providers But Offer Patients More Health IT Tools
Commonwealth Fund | December 10, 2019

Primary Care Spending in the Commercially Insured Population
JAMA | December 10, 2019

Characteristics of Americans With Primary Care and Changes Over Time, 2002-2015
JAMA Internal Medicine | December 16, 2019

Upcoming Events & Conferences

Primary Care and Women's Health - Eastern Caribbean Holidays Cruise Conference
December 22-29, 2019 | CME | Miami, FL

Orthopedic Medicine for Primary Care: Neck & Spine/Ortho/Sports Med
December 27-29, 2019 | MER | Las Vegas, NV

Essential Diagnosis and Procedures for Acute and Primary Care Providers
January 17-18, 2020 | St. Louis University | St. Louis, MO

Mayo Clinic 5th Annual Update on Infectious Diseases for Primary Care
January 17-19, 2020 | Mayo Clinic | Phoenix, AZ

16th Annual Pediatric Specialty Update for the Primary Care Physician
January 24, 2020 | Swedish Medical Center | Seattle, WA

Primary Care Update 2020
January 23-25, 2020 | University Learning | Bonita Springs, FL

Essentials of Primary Care Psychiatry Conference
January 24-25, 2020 | California Psychiatric Association | Newport Beach, CA
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