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Premier’s Edwards on the Complexity of the Current Policy Landscape Around Risk

Published in: Healthcare Innovation
Clip below. Read the full interview here.

Mark Hagland, editor, Healthcare Innovation: Let’s talk a bit about the differing trajectories around physician groups and hospital-based organizations, when it comes to taking on two-sided risk. Medical group leaders are seizing that opportunity earlier and faster. What are your thoughts on that phenomenon?

Seth Edwards, Vice President, Strategy, Innovation and Population Health, Premier: Yes, it’s an interesting situation.

What we’re seeing is that there are a lot of models that are being promulgated by CMS [the Centers for Medicare and Medicaid Services] and CMMI [the Center for Medicare and Medicaid Innovation]. And what we’re seeing is that there are a large number of models being promulgated, with private payers following up on those closely, with many of them focused on primary care and physician groups. Primary Care First and the Primary Care Plus Initiative were designed with a focus on primary care first. And we’re seeing health system employees and others enrolled.

But, with regard to broader programs like MSSP [the Medicare Shared Savings Program] and the Next Generation ACO model, we’re seeing more physicians taking on risk, but there are also programmatic design elements, particularly in the MSSP, that are driving that. If you’re a low-revenue provider, as defined by the program, you can spend longer time in lower risk, and thus, that creates more of an incentive for primary care physicians to move into that model.

Still, a large number of health systems and health system-affiliated medical groups involved. So I do think we’re seeing a large number of employed-physician groups affiliated with hospitals, involved in those models.

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