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   RE: opportunity for imps Please respond?
 From: Peter Liepmann
 To: Member Forum
 Posted: 05-13-2017 13:56
 Message: Jean, this is a SPECTACULAR idea!!
If you're open to suggestions for improvements, I'd like to work on this.
You probably saw the AAFP Advanced Alternate Payment Method (AAPM) proposal to PTAC. I posted a link to it a few weeks ago. It has great intro and background info, which you could probably borrow for another AAPM. (I'll ask.) I'll cross post on the small groups MIG.

I think you're selling yourself cheap, especially for the Medicare population.
AAFP proposed 12% of the expected gross costs to go to primary care.  The annual per capita Medicare spending  for folks over 65 is $9972.
$9972 *0.12/12=  $99.72 PMPM.  The current primary care spend, IIRC, is about 5%, so that would be ~$40 PMPM. They need to spend more to get truly comprehensive primary care.  IIRC, 2/3 of Medicare patients have >2 chronic conditions, so would  currently qualify for the ~$42 pmpm FFS CCM fee, which hasn't taken off because CMS decided the deductible/copay had to be applied.  No need for that in a capitated model.

That $99.72 PMPM is the average for primary care.  Primary care spending is highly skewed, though not as skewed as total spending, and can partly be predicted by 'disease count' and various other measures. There's about twice as much skewness for total costs as primary care, (look at slide 4) so we could use the publicly available HHS-HCC (HHS's tool to estimate costs for MA) averaged with the mean cost to make an estimate of primary care costs, risk-adjusted for disease.

I'm pretty sure you'd want this to be an AAPM, which has some very specific requirements.  I'll go check on these and post more later.
But in any case, this is a GREAT idea!!!

Peter Liepmann MD FAAFP MBA
My mission is to fix US health care
Bakersfield CA
Original Message:
Sent: 05-09-2017 22:33
From: Jean Antonucci
Subject: opportunity for imps Please respond?

Dear IMP Community,
 For years  IMP has struggled with how we might work together to improve payment or  work on  advocacy  measures despite the fact that we are  spread out across  all the states, with each state having various initiatives around cost/quality/practice transformation efforts/programs  payment etc.We spend time telling stories about "well  what  I  do is" when  the  one listening often  has no power to utilize such stories in their environment.
Tres frustrating

 Our time has come
What we have  been unable to do is now possible
 The law called MACRA established a board or committee called PTAC (Physician Payment Technical Advisory Committee- like SO not any clever acronym but at least it has a vowel so you can  pronounce it:) )- to evaluate new methods to pay docs. Any doc or any  group can make a proposal to this group  The proposals  would be around  the structure of payment and must be  nothing  done  before, be about value over volume and measure  quality  to prove its worth

 Although IMP has been a community that supports practices in practice management, we originated in the idea  of a project that would use innovative measuring and cutting edge tech to pursue practices that were sustainable for the docs and  provide the best care for patients. Those of us that went through the IMP project  cohorts or attended IMP Camps  know the details.

A few  of us have gotten together on the iMP calls and email and agree we should make a proposal
we have a good friend on the committee who  would help us

The basics are: us simply and better
Roughly $1.00( maybe more)/patient/day  (- -  have 1,000 patients?   so-$365,000 into your practice and so say the overhead is 50%, you the doc get  $182,500.) You can take of people for 1.00/day We might risk adjust it but   for this  post we are  keepin gitismple.
2 use HowsYourHealth to measure and risk assess.
 There are details Not for this email

I need a lot of patients to do this I need a lot of docs.
 Please respond to me at if you are  interested inpartcipating
 we need you to take straight ordinary Medicare as payment would apply to them only, we need you to be willing t o use HYH   60 + surveys/yr ( its free)We  may need you to do a little work for the proposal  but I am hoping  a small steering group can  put it together .

We have a good chance this project will be  accepted( which means recommended to DHHS who may put it into action)

If you want  simple pay  better  pay and to get  out of  some of the  administrative measurement junk, please email me
I need this SOON  I need you to  be willing to recruit 1 or 2 or 10 other docs also

Frankly, why wouldn't you?

Jean Antonucci

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