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ACP 'Medical Neighborhood Model' Payment Model Pilot Being Recommended to HHS Secretary

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ACP’s proposed multi-payer model seeks to strengthen relationships between primary care specialists and other specialist physicians 

Sept. 25, 2020 (ACP) – The American College of Physicians recently passed a significant milestone with its Medical Neighborhood Model (MNM), which was developed in partnership with the National Committee for Quality Assurance (NCQA).

A federal committee in September voted unanimously to forward ACP and NCQA’s MNM to the Secretary of the U.S. Department of Health and Human Services (HHS). The Physician-Focused Payment Model Technical Advisory Committee (PTAC) supported ACP’s recommendation to pilot the new model, which aims to strengthen relationships between primary care specialists and other specialist physicians.

“After three years of our efforts, that’s really, really good news,” said Shari Erickson, ACP vice president for governmental affairs and medical practice. If the MNM is implemented, she said, “it will provide a great number of opportunities for subspecialists and other specialists to more effectively coordinate care with their internal medicine colleagues and other physicians providing primary care, which will open up access and allow those specialists to see more urgent cases sooner.”

PTAC, mandated by the Medicare Access and CHIP Reauthorization Act of 2015, recommends new physician-focused payment models to the secretary of HHS for possible implementation within the Quality Payment Program. “Many members of the panel are physicians,” Erickson said, “giving them an important voice in the process.”

 “However, there’s been a major hitch. While some components of the recommended models have been implemented within CMS models, to date, HHS has not adopted any of the committee’s suggested models,” Erickson said. 

ACP considers PTAC to be a crucial pipeline for new physician-focused alternative payment models. In August, ACP sent a letter urging the committee to prioritize models that 1) fill the current void of models for subspecialty care internists, particularly those that are scalable across a range of specialties; 2) encompass a significant portion of payments and/or patients; 3) improve continuity of care across settings; and 4) offer predictable, fixed payments. “The MNM would help to fill all of these gaps,” Erickson said. 

“The model also aligns with many of the goals in ACP’s New Vision, which lays out ideas for how to better structure payment delivery; goals such as increasing investment in primary care, addressing inequities and better aligning incentives to improve patient outcomes; and ways to better leverage health information technology so patients can receive the best care when and where they need it,” Erickson said.

“ACP’s proposal also builds on ACP’s 2010 concept of a Patient-Centered Medical Home Neighbor, which emphasizes coordinated, team-based care across settings with the Patient-Centered Medical Home assuming overall responsibility for providing ‘whole person’ primary care and coordinating care and the specialists offering appropriate guidance and support,” Erickson said. “The critical missing piece the MNM brings is the necessary funding support.”

The proposal is envisioned to begin as a pilot program for a set of subspecialty practices that are already working with Primary Care First or Comprehensive Primary Care Plus practices. “We’re ensuring that the primary care practices are meeting certain standards that CMS already knows, trusts and uses,” Erickson said. 

Among other features, the proposal encourages more meaningful engagement between primary care specialists and other specialists. The aim is to address concerns by specialists about referrals that are sometimes inappropriate or misdirected.

“One of the key components of our recommended model is the prescreening of patients by the internal medicine subspecialists and other specialists as to whether or not they believe the referral is appropriate,” Erickson said. 

The model also encourages feedback from specialists to primary care physicians about patients. “Primary care physicians get frustrated because they may refer someone and don’t ever get a sufficient report back from the specialist. We’re envisioning a two-way street to ensure that coordination actually happens and is meaningful,” Erickson said. 

Going forward, the committee will submit its full report to the Secretary of HHS officially recommending the model be piloted, as well as identifying possible elements of the model’s design that may need to be further developed or reworked.  Then it will be up to HHS to decide whether to test or implement the model. ACP is committed to continuing to revise and improve the model as necessary and continue supporting it on in its path to possible pilot testing and eventually full-scale implementation. 

“We’ve been actively working to provide opportunities for internists to be able to meaningfully participate in alternative payment models,” Erickson said. “The MNM is a culmination of some of our most crucial efforts on that front.”

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Back to the September 25, 2020 issue of ACP Advocate