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Focus on Primary Care Puts ACOs on the Path to Success, New Report Finds

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Sept. 7, 2018 (ACP) – What's the best way forward for Accountable Care Organizations? Evidence shows they should prioritize primary care and advanced models like the Patient-Centered Medical Home (PCMH), declares a new report from the Patient-Centered Primary Care Collaborative, a coalition of organizations that includes the American College of Physicians.

According to the collaborative's White Paper summary on the report, “a strong foundation of advanced primary care as embodied in the PCMH is critical to the success of care delivery reforms.” The report adds that “policies that encourage a strong primary care orientation for ACOs should be considered.”

Shari Erickson, ACP's vice president for governmental affairs and medical practice, expects the report's unequivocal findings will be influential.

“This report, which relies on the findings of policy research, is quite helpful from an advocacy perspective,” Erickson said. “It's a valuable tool to help us emphasize the importance of primary care, particularly the Patient-Centered Medical Home, when we meet with policymakers on Capitol Hill or within the Trump administration.”

In 2006, ACP joined with a wide range of public and private organizations to found the Patient-Centered Primary Care Collaborative. Members include fellow clinician societies, major employers such as IBM, insurers, consumer groups and more – all devoted to promoting and sharing best practices that achieve the “quadruple aim”: better care, better health, lower costs and greater joy for clinicians and staff in delivery of care.

“They've gathered the research around innovative primary care models like the Medical Home in one place so we can look at it as a whole and use it to push for future innovation,” Erickson said.

The latest report includes not only a synthesis of peer-reviewed literature but also a new qualitative analysis and a thematic analysis of comments made by convened experts. Among its findings:

  • The qualitative analysis finds that, after adjustment for organizational and beneficiary characteristics, “Medicare ACOs with a higher proportion of PCMH primary care physicians were more likely to generate savings.” In addition, “Medicare ACOs with a higher proportion of PCMH primary care physicians demonstrated higher quality scores, including on a significant number of process and outcome measures.”
  • “At the same time, these findings suggest that a strong foundation of advanced primary care as embodied in the PCMH is critical to the success of care delivery reforms focused on keeping people healthy and preventing illness, managing chronic conditions to reduce hospitalizations and ER visits, better meeting patient needs and preferences, and reducing costs, among other goals.”

The White Paper also notes that, “with 10 percent of the U.S. population in ACOs and growing, and more than 20 percent of primary care physicians practicing in PCMHs, these findings have widespread applicability for public and private policymakers who should consider evolving these programs to promote synergy between them.”

The report recommends that, moving forward, “PCMHs should consider the broader ecosystem in which they practice and consider how to align with ACOs that have a primary care orientation.”

For ACP, Erickson said, the report “gives us a valuable evidence base as we look to improve upon Accountable Care Organizations and the Medical Home.”

“We can draw upon this work on a national level, and even members in our chapters can use this to help improve understanding about these issues,” she said. “It's especially helpful that it's backed up not just by evidence and research but also by the multiple stakeholders that are part of the collaborative.”

More Information

The full report, “Advanced Primary Care: A Key Contributor to Successful ACOs,” is available on the collaborative's website.

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Back to the September 07, 2018 issue of ACP Advocate