Q&A with Bill Golden and Susan Edgman-Levitan, Chairs of Primary Care Payment Model Work Group
Many thanks to everyone who submitted nominations and referrals for the new Primary Care Payment Model (PCPM) Work Group. We received over 130 nominations and appreciate the high level of engagement and enthusiasm for this work. We recently sat down with Work Group chairs, Bill Golden and Susan Edgman-Levitan, to get their views on the group’s charge:
Edgman-Levitan: New payment models can help reduce the stress on primary care providers, which is driven, in part, by our current productivity-based payment model. Clinician burnout is a huge issue and will create more access issues for patients if we don’t create payment systems that support practice transformation solutions, patient engagement strategies, and teamwork and coordination across the continuum of care.
Golden: The current financing of primary care can limit innovation and promote professional dissatisfaction because of overhead concerns that drives high volume, acute care visits. Payment reform can shift incentives to reward success in patient centered, coordinated chronic care management and provision of preventive services. Breaking away from current fee for service formats could revitalize primary care and result in a more sustainable health care system.
Golden: There is a timely opportunity to redesign primary care payment and increase patient-centered care, improve professional satisfaction of doctors and nurses, and bend the cost curve of the American health care system.
Edgman-Levitan: I am committed to revitalzing and redesigning our system of primary care to support our clinicians, staff, patients and families in their pursuit of good health. I believe that new payment models can help foster this and have never seen sucn alignment for this on the part of cms, other payers, clinicians and the public. I also am excited about the opportunity to work with dr. Golden who has been such a leader in this work.
Golden: We will review the impact of current payment structures on limiting patient-centered care and innovation in primary care. From there, we can design principles of reimbursement that can lead to a better future.
Edgman-Levitan: In addition to that, I hope we can do an environmental scan of new payment models in action that we might advance more broadly.
Golden: The LAN is a large, engaged community of diverse stakeholders who understand the need to restructure payment to reward health system stewardship. The opportunity for widespread dissemination of the Work Group white paper online, through webinars, and at national summit meetings will result in extensive discussion and proactive suggestions for improvement. I am optimistic that the LAN process will produce an effective roadmap for adoption and adaption by delivery systems throughout our communities.
Edgman-Levitan: The LAN participants can be helpful as a “test bed” to pilot new payment models and evaluate their impact. Feedback from diverse participants will also be helpful to create a consensus to move forward with this important work.
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Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
