By Nancy Smit, Partner and Director of the Healthcare Division at RS&F

This is the third time this year the 72-year-old man has landed in the emergency department of his community hospital with chest pain. After a thorough assessment that includes an ECG, blood tests, chest X-ray, and CT scan, the treating physician determines the patient is not having a heart attack—he forgot to refill his angina medication prescription and had missed several doses.

This scenario is far more common than it should be, especially for people age 65 and older. According to the Centers for Disease Control and Prevention, 85.6% of Americans over 65 are living with one chronic health condition and 56% are living with two. Often these conditions are not well managed, leading to frequent ED visits, poorer health outcomes, and higher healthcare bills for both patients and payers. The Maryland Department of Health (MDH), in partnership with the Centers for Medicare and Medicaid Services (CMS), is working to change that.

Maryland is in the process of transitioning to a Total Cost of Care All-Payer Model for Medicare beneficiaries. Transforming the role that primary care physicians play is a key component of this new model. To drive this transformation, MDH is launching a new initiative—the Maryland Primary Care Program (MPCP). Applications for the program are open to Maryland primary care practices serving Medicare beneficiaries from August 1 – 31, 2018. Practices selected to participate will be notified in the fall and implementation begins January 1, 2019.

Under this pilot program, which is based on the Center for Medicare and Medicaid Innovation’s (CCMI) Comprehensive Primary Care Plus Model, Maryland Medicare beneficiaries will have their care proactively managed by an interdisciplinary care team led by a primary care physician. Currently, people seek out their primary care physician when they’re ill or it’s time for their annual exam. Under the program, there’s an opportunity to elevate the role of primary care. Primary care physicians, nurse practitioners and physician assistants will become care quarterbacks and reach these patients and their other care providers more frequently, have ongoing communication with them, and shift the focus from treating illness as it arises to preventive care and care management. Primary care practices also have the option to partner with Care Transformation Organizations (CTOs) that provide care management resources, infrastructure, behavioral health support for patients, and technical assistance.

The goal of the program is twofold—to improve patient outcomes and cut spending, for Medicare and patients, on the higher cost care, like emergency care and hospitalizations, that come into play when a patients’ health is not proactively managed. In addition, participating primary care providers will receive some additional funding for their Medicare patients’ care management role they’ve long played.

The Keys to Successful Practice Transformation
This shift will require many primary care practices to implement, embed, and sustain some new procedures and processes, including having 24/7 access to care, assigning patients to care teams within the practice to ensure continuity of care and stratifying patients by risk, using a certified electronic health record (EHR), and connecting with CRISP, Maryland’s regional electronic health information exchange.  Implementing these requirements is not only the key to being successful with the Maryland Primary Care Program, it will help the participating practices avoid having to repay program funds they receive if they do not implement and sustain these processes.

The first step in the process of preparing the practice to meet the program’s requirements is for interested primary care practitioners to visit the Maryland Primary Care Program website, which includes tools that can help practices implement and embed the required processes, as well as access the program application. Other helpful resources include the practice management section of the American Academy of Family Practice’s website and practice consultants who focus on practice transformation.

To be successful with the Maryland Primary Care Program, practices will need to commit to fully participating and ensuring that all staff members understand the requirements and goals of the program. Ongoing education and open communication channels within the practice will help that commitment to remain strong.

The benefits of participating in the program go beyond improved patient outcomes and satisfaction and additional payments from Medicare. Physicians and medical staff who take on this proactive role are reporting  that they are much more satisfied with their jobs because they have the opportunity to coordinate care, focus on providing quality care, and spend more time meeting patient needs.

This is an exciting moment in healthcare. By participating in the Maryland Primary Care Program, primary care physicians have a unique opportunity to lead the revolution to help transform healthcare not only in the State, but, if the program is a success, across the nation.