Role model

How a value-based payment program is paying off

Anthony Vecchione//July 22, 2019//

Role model

How a value-based payment program is paying off

Anthony Vecchione//July 22, 2019//

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Marlton-based provider group Consensus Health has seen significant improvement in patient outcomes and lower costs since it was formed in the summer of 2018 thanks in part to Medicare’s Comprehensive Primary Care Plus (CPC+) program.

Dr. Marc Feingold, director, Consensus Health.
Dr. Marc Feingold, director, Consensus Health. – AARON HOUSTON

CPC+ is a national advanced medical home model designed to strengthen primary care through regionally based multi-payer payment reform and care delivery transformation.

The program rewards physicians for keeping patients healthy and lowering overall costs of care.

According to the Centers for Medicare & Medicaid Services, CPC+ includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of U.S. primary care practices.

Consensus does not decide which practices participate in CPC+. Each practice must apply to CMS and then they are selected to participate. The group will support practices and encourage them to participate – it is part of their goal to have every primary care practice perform in an optimal state. By doing so, they may be selected by CMS.

Nadia Adams, senior vice president of population health and care innovation for Consensus Health’s management services organization, called Dr. Marc Feingold, a primary care physician and medical director at Consensus, a national role model for how primary-care providers can help both their patients and their practice thrive.

Adams said in the current health care environment, it behooves doctors to participate in new payment models to succeed and sustain their practice.

Feingold, who joined Consensus Health in November of 2018, has been recognized by both CMS and Horizon Blue Cross and Blue Shield for his expertise in their value-based programs.

“My model is to treat patients and keep them healthy because it is easier to treat them when they’re healthy than when they become sick,” said Feingold.

“The old model of trying to get paid when patients are sick does not benefit myself or the patient. But as a good primary care doctor, I want to prevent patients from getting sick by controlling blood pressure, providing diabetes management, and encouraging mammograms, and colonoscopies.”

So far, the CPC+ program and Feingold’s persistence and focus on preventive medicine has yielded positive outcomes.

Between 2016 and 2018, Feingold was able to reduce hospitalizations by 26 percent for his Medicare patient population; reduce emergency room visits by 32 percent for that group; and increase his patients’ pneumonia vaccine rate from 52 percent to 93 percent for his eligible patient population.

Partnering with behavioral health professionals has also paid off for Feingold and Consensus Health.

Eighty-nine percent of those screened for depression showed improvement between the first and most recent screening.

Patients had a 60 percent average reduction in their depression scores and overall medical cost savings for behavioral health patients was over 30 percent.

“Behavioral health is a very big part of being healthy in general,” Feingold said. “It affects your life and if untreated can make chronic conditions worse. If you include treatment for behavioral health it will improve patient’s lives throughout all aspects.”

“At Consensus we have a behavioral health screening that’s done on every patient and we have a service that we work with that helps treat patients,” said Adams.

Feingold pointed out that many patients do not understand what preventive care medicine is but when he explains to them the advantages of catching things early, they are generally receptive.

“It’s much easier to do a colonoscopy and try and prevent the poor outcomes from untreated colon cancer. Similarly, it’s easier to get the pneumonia vaccine rather than treat the pneumonia in the ICU because someone can’t breathe.”

Adams said that Feingold does a good job explaining to patients why these metrics-preventative measures are important.

“He has designed and created a practice that makes sure that everyone in his office works at the top of their license to contribute value to the patient,” said Adams.

The feedback from patients has been good, Feingold said.

“They know that I’m coming from a place where I really care about them and want to keep them healthy.”

Feingold said that the value-based payment model has been successful.

“The way health care is going in the future, moving away from fee-for-service, getting paid for good results and keeping patients healthy is going to eventually drive health care costs down.”