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The debate over the Affordable Care Act has demonstrated one clear fact: No one thinks our health care system is working as well as it should be for most Americans. There is agreement that costs are too high, quality is not as evenly distributed as it should be, and the way we pay our doctors, hospitals and other providers of health care just doesn’t work anymore.
Now is the time to seek out the ideas and policies that will begin to answer these tough questions. It is not the time to shut down ongoing programs that are testing ideas designed to solve these critical questions. Unfortunately that is what the Centers for Medicare and Medicaid Services is about to do with the Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration program.
Over the last decade, CMS has been a key player in the testing of new and innovative ideas designed to better treat patients with multiple chronic conditions, who everyone agrees drive up health care costs and who can benefit tremendously from well-coordinated, quality care. The MAPCP demonstration program, which launched in 2011, is designed to help us address these key issues. But much like patients themselves, pilot projects like this do not fit neatly into a framework that has been drafted up back in Washington. Once reality hits, the best laid plans need to be adjusted based on new facts and information. As the MAPCP has unfolded, it has become clear that the original timeline for the program, which is set to expire this year, was misaligned with the goals and requirements of the initiative. Now, the program is at risk of being terminated before there has been any determination as to whether it is effective. This means three years of investment could essentially be lost and, worse, the important initiatives set forth by the program would be stopped in their tracks.
The MAPCP is an important example because the type of care it aims to facilitate is precisely what so many in the health care community say is imperative to reform. Under the MAPCP demonstration, CMS participates in multipayer reform initiatives currently being conducted by certain states (8 total) to make advanced primary care (APC) practices, or “medical homes,” more broadly available. CMS pays a monthly “care management” fee for beneficiaries receiving primary care from APC practices. APC practices are important because they utilize a patient-centered, team-based approach to care. This interdisciplinary approach to care avoids the silos that are far too common in treating patients that receive services across a variety of providers. Under this approach, APC practices focus on prevention, care coordination and shared decision-making among patients and their providers, especially helpful approaches for integrating care and aligning services for those with multiple chronic conditions.