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Medicare's New Healthcare Model: Making Care Primary

In an effort to enhance the delivery of healthcare services and improve patient outcomes, on June 8, 2023, Medicare announced a 10 ½ year groundbreaking initiative known as "Making Care Primary"*. This new healthcare model aims to revolutionize the way medical services are provided, placing emphasis on preventive care, early disease detection/decline, and coordinated Value Based Care. With its innovative approach, Making Care Primary promises a host of benefits and sets ambitious goals to transform the healthcare landscape.

Benefits of Making Care Primary:

1. Patient-Centered Approach: At the core of Making Care Primary is a patient-centric philosophy. The program aims to build stronger relationships between patients and their primary care physicians. By promoting continuity of care and fostering trust, patients are more likely to be actively engaged in their health management. 2. Preventive Care Emphasis: Rather than the traditional reactive approach, Making Care Primary focuses on prevention. By encouraging regular check-ups, screenings, and vaccinations, the program aims to detect potential health issues earlier, leading to better health outcomes and reduced healthcare costs. 3. Comprehensive Coordination: Under this new model, primary care physicians take on the role of coordinators for their patients' healthcare journey. They collaborate closely with specialists, home health agencies, and other healthcare providers, helping the patient navigate our complicated healthcare system.

4 Social Determinants of Health (SDoH): There is growing recognition that health outcomes are not solely determined by medical care but are also influenced by SDoH, such as housing, education, income, and access to healthy food. To address SDoH, the model includes:

a. Screening and Referral Programs: Primary care physicians are equipped with tools to screen patients for social needs. When SDoH are identified as barriers to health, physicians can refer patients to appropriate community resources and support services. b. Community Partnerships: Making Care Primary fosters collaborations with community-based organizations to extend healthcare beyond traditional brick-and-mortar medical facilities. c. Holistic Care Planning: Knowing and understanding a patients’ SDoH allows providers to develop more comprehensive and customized treatment plans.

5. Improved Access to Care: Making Care Primary aims to enhance access to primary care services, particularly in underserved populations. By reducing barriers to care and expanding telehealth, virtual care, and remote monitoring, patients can receive more timely and convenient care. 6. Chronic Disease Management: With an aging population, managing chronic conditions becomes increasingly important. Making Care Primary implements strategies to effectively manage chronic diseases, reducing hospitalizations and improving patients' quality of life. 7. Cost Savings: By shifting the focus to preventive care and reducing unnecessary hospitalizations, the program expects to generate significant cost savings in the long run.

The Role of Technology: Remote Patient Monitoring: A crucial aspect of Making Care Primary is the integration of technology, particularly Remote Patient Monitoring. RPM (or my preferred terminology- Personal Health Monitoring-PHM **) leverages digital health tools, wearables, and sensors to track patients' vital signs and health metrics remotely. This technology allows timely monitoring of patients' health conditions in their home and/or work environment. By implementing PHM, Making Care Primary can achieve the following:

1. Continuous Health Monitoring: PHM enables continuous monitoring of patients with chronic conditions and those at increased risk of health complications. Providers can receive intelligent alerts when vital signs deviate from normal, allowing for timely interventions. 2. Personalized Care Plans: PHM data provides valuable insights into individual patient health trends, enabling primary care physicians to create personalized care plans tailored to each patient's specific needs. 3. Early Detection and Intervention: With PHM, providers can detect potential health issues at an earlier stage, preventing or slowing disease progression and reducing hospitalizations.

Value-Based Care (VBC) Integration: Another significant aspect of Making Care Primary is the incorporation of VBC principles. VBC promotes quality care and accountable care, rather than the quantity of services rendered. In this model, providers (especially rural and small groups) are provided a pathway and are incentivized to participate in VBC programs.

Conclusions: Medicare's Making Care Primary initiative represents a significant step forward in potentially transforming healthcare for millions of patients. By prioritizing preventive care, patient-centric care coordination, leveraging technology like Personal Health Monitoring, and incorporating value-based care principles, this model seeks to improve health outcomes, enhance patient satisfaction, and make healthcare more accessible and equitable. As the program continues to evolve and expand, it has the potential to shape a healthier, more cost-effective, and more sustainable future for the nation's healthcare system.

** PHM- Personal Health Monitoring is my preferred terminology, as Remote Patient Monitoring ambiguously can mean anything from a phone call to live-streaming ECG data. “RPM” also refers to both Remote Physiologic Monitoring and Remote Patient Monitoring.


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