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   RE: opportunity for imps Please respond?
 From: Jennifer Mcconnell
 To: Member Forum
 Posted: 05-14-2017 07:50
Jean, I have 250ish Medicare patients.  I think this is a great idea, it is similar to DPC concept, I take care of patients for a set amount.  I can take the energy of fighting insurance to taking care of patients.  Thank you for working on this!

Maranacook Family Health Care is in!

Jennifer McConnell, MD
Maranacook Family Health Care
169 South Road
Readfield, Maine 04355
Patient Portal:

------Original 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

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