News & Commentary

Anthem’s Jill Hummel Discusses Sustainable Payment for High-Performing Primary Care at the PCPCC Annual Fall Conference

November 28, 2016

Primary care is a crucial part of an effective and efficient health care system, especially as health care policy, public health trends and consumer habits evolve. The majority of stakeholders agree that primary care is the cornerstone of all health care, but opinions vary on the best way to pay for it.

On November 10, 2016, Jill Hummel, president and general manager of Anthem Blue Cross Blue Shield of Connecticut, moderated the panel, “Sustainable Payment for High-Performing Primary Care: How do we get from here to there?” at the Patient-Centered Primary Care Collaborative (PCPCC) Annual Fall Conference. She was joined by panelists Dr. Robert Berenson, an Urban Institute Fellow; Christine Bechtel, CEO of Bechtel Health; Suzanne Delbanco, Executive Director at Catalyst for Payment Reform; and Dr. Laura Sessums, Director of the Division of Advanced Primary Care at Center for Medicare and Medicaid Innovation.  

Hummel led a conversation that explored the intricacies of sustainable payment for high-performing primary care. The panelists unraveled some of the complexities of primary care, resulting in the following insights:

Before sustainable payment models for high performing primary care can be developed, high performing primary care must be defined. 

  • Panelists agreed that high-performing primary care is a team effort. A patient should have an entire care team that is responsive and available—and that focuses on individual patients, while still keeping in mind the population dynamics of all their patients. 
  • Panelists also said high-performing primary care advances access to care and multichannel access between patients and providers. This accessibility empowers and engages patients, and renders every interaction between primary care team and patient more meaningful. Hummel noted that it is essential to make people “active participants in their own health.” 

Sustainable payment models should reward comprehensive primary care that promotes improved quality, health and access while reducing costs. 

  • Panelists agreed that any sustainable payment model must transition away from the fee-for-service model and be replaced with some form of comprehensive payment solution. Fee schedules have limitations—and do not promote robust interactions between patient and provider.
  • One panelist noted that at the outset, health care stakeholders must agree to pay more for primary care—it has long been neglected and undervalued. Hummel underscored this on the sidelines of the panel, saying that primary care interactions are crucial in addressing three of health care’s biggest cost drivers: poor diet, lack of exercise and smoking. 
  • When asked about the biggest challenge in determining sustainable payment models, Hummel said that one of the greatest challenges is minimizing the unintended consequences because all payment models create a series of incentives and disincentives that work together. 
  • Panelists agreed that the CPC+ model from the Centers for Medicare & Medicaid Services (CMS) shows promise to improve primary care delivery and make administrational tasks less burdensome. 
  • There was unanimous agreement that whatever model of payment prevails, it must include measurement protocol. At present, payment data is only sporadically available. The exception is claims data from payer organizations, which can be used to measure effectiveness of quality of care and utilization. 

Relationships are the cornerstone of successful payment models and primary care systems.

  • Anthem’s Julie Schilz, staff vice president of care delivery transformation, commented on the sidelines of the event that in addition to the complexity of the system, health care leaders must also account for the various needs of different stakeholders—including commercial payers, CMS, providers and of course patients. Any payment model for primary care must take each of these stakeholder groups’ sensitivities under consideration. 
  • Panelists also noted that patients should be empowered to assemble their own care team, based on their individual needs.
  • Hummel noted that providers can improve their patient relationships by improving access, with technology and telehealth enabling more efficient and useful interactions. 
  • Panelists urged attendees to consider the language barrier between health care industry insiders and patients, particularly when talking about health care payment. For example, terms like “quality incentives” can be off-putting to a patient.

Policies aren’t perfect, but they drive the industry, and primary care, forward. 

  • Panelists agreed that health care is not a market driven economy—it is policy driven. One panelist noted that policy points us in the right direction but it is a blunt instrument. Current policies, and many of the policies of the last decade, have moved the field in the direction of transparency and a patient focus.

 

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