CMS Initiative is a Major Victory for Community Prevention
Evidence is mounting that the path to advancing health in the U.S. is to practice community prevention alongside high-quality medical care. Yet, many health leaders have said community prevention is impractical for healthcare providers, because it’s not what they are paid to do. This is why last week’s announcement by the Centers for Medicare & Medicaid Services’ (CMS) of the new Comprehensive Primary Care Plus (CPC+) initiative is so important. It allows and encourages clinicians to focus on primary prevention—on keeping patients healthy in the first place.
The CPC+ initiative does this by moving away from the traditional fee-for-service payment structure and towards paying doctors upfront to improve health outcomes. Those upfront payments gives physicians the freedom to care for patients in the ways they feel will lead to best health outcomes, instead of being tied to billing for specific services. Community prevention is clearly a big part of improving outcomes. Indeed, the day after CMS’ announcement, a major journal article reported that large investments by the Centers for Disease Control and Prevention in community prevention “could yield cost savings many times greater than the original investment over 10 to 20 years, and avert 14,000 premature deaths.”
In announcing the CMS initiative, Dr. Patrick Conway, CMS deputy administrator and chief medical officer, noted the importance of going outside the clinic walls to improve health, saying a key goal of CPC+ is to “serve patients’ needs outside the doctor’s office.”
As with any change in payment structure, we need to ensure this initiative is implemented in a way that doesn’t disadvantage patients with the greatest need. We believe this is possible, and that the payment model can in fact lead to greater health and equity in communities that have been left behind, as well for the entire U.S. population.
Even before this funding initiative, there’s been growing momentum for community-centered health in the healthcare field. In the last five years, healthcare facilities from California to the Gulf Coast to North Carolina to Vermont have worked to improve community conditions—like housing, parks, access to healthy food—that impact health. We’ve seen them address diabetes and heart disease by improving access to healthy food and safe places to be active. We’ve seen them tackle asthma by looking into the housing conditions that can exacerbate respiratory illness.
The new CMS payment structure gives clinicians a financial incentive to work beyond medical facility walls to address these kinds of community conditions. In the process, they can unlock healthcare data and uncover new ways to coordinate and integrate care to improve quality.
Encouraging providers to preserve the health and well-being of their patients is a win for the economy, and it’s a win for the notion that every person deserves the opportunity for optimal health. By shifting payment rules, momentum will continue to build among healthcare leaders that community prevention is an effective, efficient, and moral approach to improving the lives of their patients. A true culture of health for all is within reach.