Value Based Care?

On June 8, 2023, Centers for Medicare and Medicaid Services (CMS) announced its 10.5-year pilot study called Making Care Primary (MCP) that will kick off in July 2024. That means you have a year to get ready. “Ready for what,” you say? The model seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and leveraging community-based connections to address patients’ health needs as well as their health-related social needs. CMS says it wants to address priorities specific to their communities, including care management for chronic conditions. 

So what’s in this for O&P? Well, initially nothing. But there is a fantastic opportunity for you to show that you truly are a value-add to the health system and a key player in the PM&R teams caring for patients with multiple chronic conditions. Once those patients need orthotic or prosthetic intervention, you are often the health care professional most familiar with them. Your ability to influence their physical outcomes and therefore their emotional outlook is often undervalued in the traditional healthcare system. 

You have an opportunity to integrate yourself with the Primary Care Physicians (PCP) in your area that chooses to participate in this model through data sharing, patient monitoring, and active referrals back to the PCP when necessary. If you are collecting outcomes data, this information will be valued more and more by the PCP and ultimately the payers. Your contribution will be recognized by the PCP which at the very least, should result in more referrals. I can’t tell you that you will be paid more. In fact, you probably won’t, at least not at first. But you won’t be paid less, you should get more patients, you should have greater confidence in your future, you will become a valued member of the care team, and your impact on your patient population will be greater than it is today. More than likely, you may get involved earlier in the care process than you have been traditionally, giving you the ability to help your patients with more appropriate and timely interventions. 

Part of Medicare’s plans is to “provide primary care clinicians with enhanced model payments, tools and supports to improve the health outcomes of their patients. It provides additional resources and data to help primary care clinicians better coordinate care with specialists.” So as a successful, innovative O&P professional, can you see a path to your own identification as an “additional resource” and a specialist with whom that PCP can coordinate care? There are probably going to be opportunities to create models that allow financial incentives for participating in this program without violating laws. I do recommend that you seek legal advice before going down that path, but I do think it is worth exploring. 

OPIE has the tools to help you effectively communicate critical information. You need a system with incredible experience, breadth, and depth to keep up with the demands you may need to place on it. We are here for you and encourage you to step out and step up for the O&P profession!