The number of older Americans is growing rapidly. The share of adults 65 or older in the United States is expected to rise from 14.5 percent of the population in 2014 to 21.7 percent of the population by 2040 (REFERENCE). While medical advances have allowed many older adults to live longer, healthier lives, many are also living with multiple chronic conditions that are likely to lead to a slow deterioration over time. Today, there are 45 million Americans considered to be “high-need” – they are living with one or more chronic conditions (such as diabetes, heart disease and chronic obstructive pulmonary disease).
Knowing this, the Moore Foundation saw an opportunity to improve the quality of care in the community for high-need seriously ill patients. In 2016, the foundation’s Patient Care Program embarked on an investigation into this space, and has since invested more than $58 million to improve the experiences and outcomes of care for the high-need patient population.
We sought to fund a few key projects meant to make high-quality serious illness care the norm and not the exception. The aim was to usher in a new patient experience of care quality – one where providers would be judged not only on statistics, but on how well they have shared decision-making conversations with their patients. Ideally, Medicare would pay providers more if they received high scores when measuring patient experience.
A direct result of this work as well as support of other partners is the Medicare serious illness payment model, Primary Care First – a game-changer for the serious illness community. The new payment model indicates that the essential step of moving from measures to payment is occurring. Health and Human Services Secretary Alex Azar announced this new payment model in late April 2019, and called out two foundation grantees for their work in helping to bring it to fruition.
“The Physician-Focused Payment Model Technical Advisory Committee has analyzed a huge number of payment model ideas from physicians who are excited about innovation. Their work, including submissions from the American Academy of Family Physicians, the American Academy of Hospice and Palliative Medicine and the Coalition to Transform Advanced Care, has inspired many significant aspects of the initiative we’re announcing today.” – Secretary Alex Azar, U.S. Department of Health and Human Services
Primary Care First Model Options will be offered in 26 regions beginning in 2021. The new model is a signal by Medicare that seriously ill patients are a key population whose care needs to be improved. Now, providers will have more flexibility to configure staffing in a way that best supports patients’ needs. This will have a long-term positive impact on a critical community of patients now and into the future.