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Thursday Aug 16, 2012

Humana Support for Primary Care Is Encouraging

Last week, along with several members of the AAFP staff, I had the opportunity to meet with representatives from the health insurer Humana Inc., at the company's Louisville, Ky., headquarters. Although meetings with health plans often can be frustrating, I found a lot to be encouraged about during our three-hour conversation.

Humana representatives told us they are supportive of the patient-centered medical home (PCMH) and enhanced payment to align with it. One way the company is showing that support is via its participation in three of the seven pilot regions of CMS' Comprehensive Primary Care Initiative

The CPC Initiative, which includes both private and public payers, is a CMS demonstration program that proposes to blend fee-for-service payments with a per-patient, per-month care coordination fee in several areas of the country. The program also offers practices that participate the opportunity to earn a portion of shared savings. If the CPC Initiative is shown to improve quality and lower health care costs, CMS has the authority to expand the initiative nationwide.

Humana told us it is optimistic about the success of the CPC Initiative. In fact, the company is developing an outreach program that will help identify gaps preventing primary care practices from achieving recognition as a PCMH. The company is proposing to put actual people on the ground working in practices and providing a resource to help us succeed.

The program would help practices become eligible for PCMH incentive programs and would help them be prepared if and when the CPC Initiative is expanded by CMS. Humana told us specifically that they want to help small practices remain independent and viable.

Another interesting thing Humana is doing is offering a graded care management fee based on a practice's level of National Committee for Quality Assurance (NCQA) PCMH recognition. Some payers only pay practices that have reached level three, but Humana is offering varied payments for levels one, two and three of NCQA recognition.

This stepwise approach encourages practices to make an effort, and they don't have to achieve NCQA's highest level to benefit.

The Humana meeting was our fifth meeting with a major health plan in the past 11 months. We've also visited with Aetna, Cigna, UnitedHealth Group and WellPoint. In all of these meetings, we have emphasized the importance of fair payment for primary careincluding the need to fix the fee-for-service payment system. We also have stressed that a robust primary care system means better care for patients and lower overall health care costs.

We try to meet at least annually with these private payers and have seen incremental progress with each of them over time. They recognize the importance of primary care and the PCMH model. Clearly, there still is work to be done because certain payers continue to offer us payment below Medicare levels in some areas.

As I have said before, however, private payers may not change their policies based solely on our input, but without that input, they most certainly won't change.

Glen Stream, M.D., M.B.I.is president of the AAFP.

Posted at 11:47AM Aug 16, 2012 by Glen Stream, M.D., M.B.I.

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