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Tuesday Jan 07, 2014

Academy is Working to Define, Value Care Management

Editor's note: During the AAFP's Scientific Assembly in San Diego, a panel discussion on practice transformation generated far more questions than the panelists could answer in the time allotted. This is the second post in an occasional series that will attempt to address the issues members raised -- including the valuation of care management fees -- during the panel.

The AAFP has been advocating for years that a designated care management fee should be paid on a per-member, per-month basis as part of a blended payment model that also includes enhanced fee-for-service and performance-based incentives.

Family physicians always have done what is needed to care for our patients. We answer phone calls and e-mails, review and compile information from subspecialists, coordinate care transfers in referrals and in the hospital, handle prior authorizations, and ensure so many more aspects of making sure our patients get the care they need are covered. Although all these factors are critical for good patient outcomes, none of them generate payment for family physicians doing this important work.

The AAFP is pushing for payers to recognize the value inherent in care management services. Although we are seeing progress in this area, our efforts are complicated because of the amount of confusion -- and disagreement -- regarding what care management services should include and what they are worth. The Academy is working to define patient care management so that these services can be understood and valued appropriately.

For example, the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care has conducted a literature review that considered more than 600 studies that offered evaluations of care management fees and reimbursement in care management and/or care coordination. Sixty-one articles were deemed relevant for inclusion in the review.

The range of fees found in that review was striking, with a low of 60 cents per beneficiary per month in one demonstration to a high of $444 per beneficiary per month in a congestive heart failure program. Some payers are offering $2 to $4 per beneficiary per month. Obviously, these low numbers are unacceptable.

Some disagreement exists as to what dollar amount per beneficiary per month would be most appropriate to properly value the work required to provide high quality care, but we are working on a process to help make these critical decisions.

The Graham Center's work will be used as the basis for a concise document that defines what the AAFP considers to be the essential elements of care management fees. That document will be vetted in February during a meeting of the Academy's Commission on Quality and Practice.

The next step will be for the health care advisory firm Avalere Health LLC -- which has been working with the Academy on payment issues since 2012 -- to value the AAFP's definition of a care management fee. That valuation, the definition and the underlying literature review then will be used to create a policy document on the valuation of care management fees. That document is expected to be presented to AAFP Board of Directors later this year.

When the work is done, we'll have one seamless document we can take to payers -- both public and private -- and say, "Here is what we do for our patients. This is what care management means. It should be valued and paid for, and this is a reasonable care management fee."

The document also will be used to help AAFP members evaluate contracts that include care management fees.

We'll keep you updated on our progress.

Reid Blackwelder, M.D., is President of the AAFP.

Posted at 03:04PM Jan 07, 2014 by Reid Blackwelder, M.D.

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