Primary objective: Priority Health bets on business benefits of CPC+


Photo credit: Getty/kazoka30

Editor’s note: This is the second in a two-part series on the changing relationship between health insurers and primary care. In part one, FierceHealthPayer spoke to Harken Health co-founder Krista Nelson about her company’s innovative approach to combine health plans with relationship-based care in neighborhood clinics.

When the federal government unveiled what it deemed the largest ever multi-payer initiative to improve primary care, insurers and providers alike knew it would be a game-changer.

Experts weighed in on its implications for quality-based incentives, its projected impact on rural providers and the role technology would play, among other aspects.

But for one participating insurer, Michigan-based Priority Health, the Comprehensive Primary Care Plus (CPC+) initiative is simply an extension of the work it had already been doing, Chief Operating Officer Mike Koziara tells FierceHealthPayer in an exclusive interview.

Mike Koziara

Priority Health had been participating with providers in Michigan on a Centers for Medicare & Medicaid Services-backed primary care transformation program, Koziara notes, adding that “we believe CPC+ is a logical continuation of that work and even an improved continuation.”

There are several factors that convinced Priority Health that CPC+ was a worthwhile next step.

For one, it allows the insurer to be a leader in the transition to value-based care in a way that is consistent with other payers and other government entities.

That coordinated approach to incentivizing quality--rather than a sea of different approaches from different payers--is key because it “allows physicians to focus on transforming care,” Koziara says.

It also offers fierce rivals like Priority Health and the state’s Blue Cross Blue Shield carrier a rare chance to collaborate and learn from one another. Because there is there a greater likelihood of sustainable transformation in delivery of care with the alignment of various payers in a region, “you’re actually helping yourself out by collaborating,” Koziara says.

In addition, Priority Health’s leaders like that the program embraces the triple aim--particularly the affordability component, according to Koziara. That emphasis on cost containment, he says, should be more feasible through CPC+ because it is designed to put resources where they need to be: At the point of care.

The care management component of CPC+, Koziara explains, will pay providers on a monthly, prospective basis rather than retrospective payments based on outcomes. That point-of-care cash flow is severity-adjusted, so providers receive less reimbursement for patients who require only moderate follow-up and care management.

Such an approach to care management is effective, he says, “if you’re doing it to the right patients”--those with complex, chronic conditions--rather than applying a one-size-fits-all approach.

With all the promise that the CPC+ program holds, though, the real work will begin once Priority Health learns which primary care practices have signed up to participate, Koziara notes. Eligible practices have until Sept. 15 to apply.

Once the initiative kicks off officially, Koziara expects Priority Health’s involvement will help it grow market share and boost its membership base by providing lower-cost, higher-quality care to customers. He also sees such efforts as a critical step toward the goal of reducing unnecessary care and thus, lowering costs.

“We’re at a tipping point, and believe that how we pay over the next three to five years will and must make a difference,” Koziara says. “We’re going to put a lot into it, and we’re expecting to get a lot out of it.”