June 9, 2023

By Tochi Iroku-Malize, M.D., M.P.H., M.B.A.
AAFP President

June 8 was truly eventful for the Academy.

Yesterday morning, AAFP Executive Vice President and CEO Shawn Martin delivered compelling testimony to the Senate Finance Committee about the ways in which accelerating health care consolidation can harm primary care practices and patients. Meanwhile, an hour after that hearing started, the Center for Medicare and Medicaid Innovation announced Making Care Primary, a new, state-based, multipayer model set to advance the transition to value-based payment in line with the Academy’s advocacy.

While the spotlight on us is still warm, I want to tell you how these events are related and what they mean in the context of our fight for family medicine. As I did when I wrote to tell you about the Academy’s wins in the omnibus spending bill, I’m enlisting the help of Stephanie Quinn, the AAFP’s senior vice president of advocacy, practice advancement and policy, to best explain what June 8 was about and what to expect next.

Tochi: Stephanie, can you give me a high-level understanding of the Academy’s message to lawmakers about health care consolidation and how that intersects with our push to improve payment for family physicians?

Stephanie: The statement we submitted with Shawn’s testimony goes deep on consolidation, but in terms of how it affects primary care, we’re talking about the large-scale absorption of practices into profit-motivated health care systems. At heightened risk are independent practices rocked by the systemic underinvestment in primary care embodied by the Medicare physician fee schedule, which is a big reason we talk about payment when we talk about consolidation. Our testimony emphasized that the effects of consolidation so far have been higher prices and costs, including insurance premiums, but not better care quality or patient outcomes. And how can outcomes get better when consolidation limits physicians’ autonomy and adds barriers to equitable access to care?

Now let’s talk payment. When we spoke in January, I said that the spending package contained wins for us but also clarified where some of our challenges lay. As Shawn said in January, “A cornerstone of the AAFP’s advocacy efforts in 2023 will be calling for an inflationary update and eliminating the annual threat of Medicare cuts.” We did that in April, when we immediately got behind a bill that would use the Medicare Economic Index to anchor annual increases to the Medicare physician fee schedule’s conversion factor. The AAFP’s testimony urged passage of that legislation. In fact, the statement we sent the committee drove home our uppermost aims: bolstering primary care, protecting independent practice, reducing administrative complexity, improving payment and ensuring all patients have access to primary care.

The Academy has long said that a large-scale transition to value-based payment is imperative, and we took the opportunity yesterday to say again that Congress must unlock robust alternatives to fee-for-service medicine — not least because doing so will lessen the dire effects of health care consolidation. It’s also crucial to caring for Medicare beneficiaries long term. As we told Congress after the omnibus was signed, getting out of what’s been an exhausting cycle of Medicare payment stopgaps should go hand in hand with action to slow the alarming rate of health care consolidation.

Tochi: How does value-based payment fit into this discussion?

Stephanie: In both wholesale and component terms, fee-for-service medicine undervalues primary care, in turn priming the vertical-integration pump. Again, this jeopardizes many community-based primary care practices, but the negative effects won’t stop there.

The AAFP is bullish on well-designed value-based payment models as a chief avenue for supporting practices of all sizes working to deliver continuous, comprehensive, coordinated primary care. But to build this future, Congress must empower CMS and CMMI to do more.

Tochi: OK, speaking of CMMI, what do we know about this new model and what it might mean for family medicine practices?

Stephanie: Making Care Primary was just announced, and our readout of the details is just getting underway. I want to use this space to say that we will share a full analysis of the model with members as soon as this work is complete.

That caveat aside, we know three things, all of them good.

First, the very fact the model was introduced is a win for the Academy’s longtime championing of alternative payment models and our work to free practices from the confines of fee-for-service medicine. Second, and more specifically, early details indicate that the model incorporates several recommendations we’ve made over the past few years regarding value-based primary care. Third, practices in the states where CMMI will pilot this model have the AAFP’s support at the chapter and national levels. And we’ve invited CMMI to FMX to talk about the model with Academy members in applicable states.

As we told senators this week, we know that AAFP members are achieving success in value-based care. We’re hearing from them that it’s simply a better way to work. We know how it benefits patients and communities. And even in a climate that’s rewarding consolidation rather than properly valuing primary care, we know that value-based care can produce revenue capable of growing primary care practices. So the introduction of Making Care Primary today is an important step forward and a win for our advocacy.

Tochi Iroku-Malize, M.D., M.P.H., M.B.A., is president of the AAFP.