A conceptual approach to payment reforms allowing for more effective collaboration between cardiology and primary care physicians in treating patients with chronic cardiovascular disease is at the center of a review published Nov. 22 in JAMA Cardiology.

The review – a result of a collaboration between the Duke-Margolis Center for Health Policy and professional societies representing primary care and cardiology, including the ACC – outlines a proposed set of payment reforms, the core of which could qualify as an advanced alternative payment model under the Medicare Access and CHIP Reauthorization Act (MACRA). It also clearly defines the roles of participating physicians under each model where they share responsibility for patient care.

Specifically, the authors define two short-term payment models including a clinician-to-clinician consultation (CTCC) model and a multispecialty care coordination (MCC) model – both of which require effort from primary care physicians (PCPs) and cardiology clinicians. With MACRA and its resulting Quality Payment Program propelling the transition from a fee-for-service system to one focused on advanced Alternative Payment Models that address population health, the authors also propose a long-term third model focused on advanced chronic cardiovascular disease. This model, based on multispecialty professional fee capitation, would bundle professional fees for participating clinicians with an established longitudinal patient care relationship.

“To provide heart disease patients with the best possible care, it is essential that cardiologists and primary care clinicians work effectively together,” said Paul N. Casale, MD, MPH, ACC Board of Trustees member and a member of the U.S. Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee. “This collaborative care framework and payment model offer an opportunity to link clinician roles and responsibilities to payment, thus improving value and the care experience for our patients.”

While the reforms focus on improving cardiovascular care, they could be adapted for a broad range of chronic health conditions that require primary-specialty care coordination. “Under this consensus proposal, patients would receive higher quality care that supports relationships with their physicians, providers would have improved pathways and support for their shared responsibility for a given patient’s health, and the health care system could benefit from better results and lower costs,” said Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy and study co-author.

Keywords: Fee-for-Service Plans, Physicians, Primary Care, Advisory Committees, Capitation Fee, Medicare, United States Dept. of Health and Human Services, Primary Health Care, Patient Care, Referral and Consultation, Heart Diseases, Cardiovascular Diseases, ACC Advocacy

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