While Nielsen was equally cagey about the full scope of this initiative when I followed up with her, it apparently will entail the federal government and private insurers funding a multipronged initiative that gives participating primary-care physicians incentives to improve their care.
The CMS innovation center is authorized under the Patient Protection and Affordable Care Act to launch such pilot programs, and it has $10 billion to pay for 10 years worth of them.
This latest initiative is separate from the already announced medical home program for primary-care clinicians. In fact, Nielsen implied it will be a distinct improvement.
“You all know that qualifying as a medical home doesn't save money, necessarily,” she told the assembled quality gurus. “It could, but it may not”.
The specific components will include helping participating physicians improve their patients' health by giving them individually tailored patient outcomes data aggregated from both the public and private insurers of their patients.
“Doctors have not seen the data they need in order to do that,” Nielsen said. “Under the initiative that has been suggested to us, they will get that data.”
Another component will require the 24-hour availability of care from at least one physician who is familiar with the medical needs and history of each patient included in the program.
“Now, no doctor can be on-call 24 hours, seven days a week but there are ways that you can handle that,” Nielsen said.
She described the use of a “team approach” that would allow even solo practitioners to participate.
At least one—unnamed—private insurer has already had positive results from a similar program, she said.
Nielsen implied the program will be unveiled in two weeks.