Apr 23, 2019

The Trump administration's new primary-care payment models

HHS Secretary Alex Azar. Photo: Alex Wong/Getty Images

The Trump administration announced a new set of primary-care payment models yesterday, an attempt to incentivize doctors to produce better health outcomes.

The backdrop: This builds on initiatives by both the Obama and Trump administrations to transition away from a fee-for-service payment system.

  • HHS Secretary Alex Azar predicted that the models will enroll 25% of traditional Medicare beneficiaries and providers. Implementation of the models — which providers must apply for — begins in 2020.

Between the lines: There are very few subjects in health care that are simultaneously bipartisan, boring and important, but value-based payment reform is one of them.

  • And if you can get through all of the wonky acronyms, it's actually not boring, because it gets at the U.S.' unique problem of having very expensive health care that is relatively poor quality.
  • By targeting primary care and using performance measures like hospital admissions, the new models lean into the theory that if doctors catch and treat conditions before they worsen, it keeps patients healthier and saves a lot of money down the road.

How it works: Yesterday's announcement includes 2 types of models: one aimed at smaller primary-care practices, and another aimed at larger practices and health systems.

  • Both tie doctors' payments to performance to varying degrees, rewarding them for good outcomes and penalizing them for poor ones.
  • But the announcement left some key questions unanswered that will be crucial to provider participation, said Evolent Health's Chris Dawe.

The bottom line: This is clearly the direction that Azar wants to head — and not just in Medicare. "This initiative is specifically designed to encourage state Medicaid programs and commercial payers to adopt similar approaches," he said in a speech.

Go deeper: Stat News has more details on the models.

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Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 3 p.m. ET: 5,931,112 — Total deaths: 357,929 — Total recoveries — 2,388,172Map.
  2. U.S.: Total confirmed cases as of 3 p.m. ET: 1,711,313 — Total deaths: 101,129 — Total recoveries: 391,508 — Total tested: 15,192,481Map.
  3. States: New York to allow private businesses to deny entry to customers without masks.
  4. Public health: Louisiana Sen. Cassidy wants more frequent testing of nursing home workers.
  5. Congress: Pelosi slams McConnell on stimulus delay — Sen. Tim Kaine and wife test positive for coronavirus antibodies.
  6. Tech: Twitter fact-checks Chinese official's claims that coronavirus originated in U.S.
  7. What should I do? When you can be around others after contracting the coronavirus — Traveling, asthma, dishes, disinfectants and being contagiousMasks, lending books and self-isolatingExercise, laundry, what counts as soap — Pets, moving and personal healthAnswers about the virus from Axios expertsWhat to know about social distancingHow to minimize your risk.
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Updated 20 mins ago - Politics & Policy

Twitter fact-checks Chinese official's claims that coronavirus originated in U.S.

Chinese Foreign Ministry spokesman Zhao Lijian. Photo: Greg Baker/AFP via Getty Images

Twitter slapped a fact-check label on a pair of months-old tweets from a Chinese government spokesperson that falsely suggested that the coronavirus originated in the U.S. and was brought to Wuhan by the U.S. military, directing users to "get the facts about COVID-19."

Why it matters: The labels were added after criticism that Twitter had fact-checked tweets from President Trump about mail-in voting, but not other false claims from Chinese Communist Party officials and other U.S. adversaries.

Podcast: Trump vs. Twitter, round two

President Trump is escalating his response to Twitter’s fact check of his recent tweets about mail-in voting, issuing an executive order that's designed to begin limiting social media's liability protections. Dan digs in with Axios' Margaret Harding McGill.

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