Below is a summary of a panel discussion on August 22, 2024 addressing innovations in healthcare policy positioned to reshape primary care. Watch the panel discussion.

The future of primary care has captured the attention of our legislators. As of fall 2024, there are several high-impact policies in review that could help primary care providers across the nation do their best work: With appropriate and fair clinical, financial, and operational legislative and regulatory support. 

A few weeks ago, I was pleased to join my colleague Penny Morris, Elation’s regulatory and compliance manager, and Jay Keese, CEO of Capital Advocates, to discuss these policies in a publicly available webinar. Penny focuses on policy analysis and building programs to meet policy changes, leading Elation’s CEHRT efforts, MIPS support for providers, and all things regulatory. Jay is a government relations and health policy professional with over 30 years of political and legislative experience in Washington.

Here are some of the policies to watch and help support in the near future, and how you as a PCP can be prepared to take advantage of progress with minimal practice disruption. 

The ONC Weighs in on Interoperability, AI, and Privacy 

The Certified EHR Technology (CEHRT) Program from the Office of the National Coordinator for Health Information Technology (ONC), is foundational to EHR functionality. To be a Certified EHR like Elation, organizations must participate and align to ongoing regulatory updates. While this is not a newly introduced program, it is notable that updates to certification were historically made in an ad-hoc manner, but the ONC is newly shifting to an annual update cycle to better align with Centers for Medicare & Medicaid Services (CMS) policies and other statutes.

As part of the recent round of updates, Certified EHRs are required to provide transparency into their AI evaluation methods, working to ensure that practices using these technologies understand that AI-driven solutions are safe and effective. Certified EHRs are also required to align to enhanced privacy controls, aligning with evolving and often complex state privacy standards and HIPAA requirements, ensuring patient data is secure during data exchange. 

This leads us to the ONC’s US Core Data for Interoperability (USCDI) standards, which define how data is structured that is shared between EHR platforms to help make system-to-system communication more effective. PCPs must have the basic technology capabilities to connect, which is increasingly relevant and necessary in preparation for data sharing measures going into effect across the country, from the ONC’s TEFCA, the interoperability floor for healthcare entities across the nation, to local efforts such as the Data Exchange Framework (DxF) in California. 

USCDI standards additionally require EHRs to update their systems to be modern, secure, and reliable, which includes using Fast Healthcare Interoperability Resources (FHIR) API endpoints. These endpoints standardize data exchange between EHR systems, helping clinicians better trust the data integrations. 

As primary care physicians, the ONC’s regulatory measures are relevant because the EHR you rely on must meet the standards and functionalities required for these systems for you to efficiently, effectively, and compliantly run your practice. And, while achieving the complex work of data sharing is a rigorous, layered, and detailed process, it does hold promise to improve the accuracy of patient records, improve longitudinal care management, and better coordinate care between many different types of healthcare delivery, wherever a patient receives care.

Payment Model Reforms: Simplifying Primary Care Compensation

There are currently three key initiatives aimed at reforming the way we pay for primary care services. These include moves towards value-aligned care delivery, with a focus on alternative ways to pay for care, such as direct primary care (DPC) and Medicare Shared Savings Programs (MSSP). These models are designed to incentivize better patient care rather than focusing solely on the volume of services provided under traditional fee-for-service (FFS) structures.

The Pay PCPs Act (S.4338) would require CMS to establish hybrid payments to reward primary care clinicians who provide the best care to their patients, delivering better health outcomes and importantly, reducing cost drivers such as emergency visits, hospitalizations, and excess specialist services. This model combines monthly payments with traditional fee-for-service, offering a more predictable revenue stream for PCPs.

The Primary Care Enhancement Act (S. 628) proposes a change to the IRS code, allowing direct primary care (DPC) membership fees to be paid out of Health Savings Accounts (HSAs). This would make DPC models more flexible and affordable for over 70 million Americans covered by employer health plans with HSAs or commercial plans with HSAs.

The Medicaid Primary Care Enhancement Act (HR 3836) allows states to collaborate with CMS to provide Medicaid beneficiaries access to direct primary care services. The legislation opens the door for Medicaid patients to receive high-value, patient-centered care through prepaid membership fees, expanding the DPC model to an underserved population.

Together, these bring more flexible payment models to underserved populations to reduce healthcare disparities. If these acts pass, millions of additional patients will have more accessible and personalized care, allowing them to more fully benefit from primary care while also ensuring clinicians are paid appropriately for the value they deliver. 

More Legislation to Watch

As Elation shared in March 2024, there are additional legislative measures that make it easier for clinicians to deliver high quality care more sustainably while also making it easier for patients to find and afford high-quality care. 

The Improving CARE for Youth Act (S.2556) eliminates reimbursement restrictions on primary care and behavioral health services delivered on the same day for children in Medicaid/CHIP. Medicaid and CHIP cover more than 80 million Americans, including a disproportionate percentage of rural individuals, low-income seniors, people with disabilities, and people of color. This will expand access to mental health services for youth by removing the barrier of billing restrictions and supporting better coordination of care.

The Chronic Care Management Improvement Act (HR 2829) removes the patient cost-sharing burden from reimbursement for the care coordination activities related to management of chronic conditions. This act is a step foward in dismantling financial barriers that prevent patients from receiving care aimed at preventing complications from chronic disease.

What PCPs Should Know 

Understanding future technology needs and concerns make you a better physician, operator and owner because in an increasingly technology-dependent world, technology that you purchase for your practice needs to be able to adapt to increasingly complex and stringent demands. This is essential to your ability to focus on your patients instead of paperwork. As the CMS aims to have 100% of patients managed in value-based contracts by 2030, understanding the role of models like the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) will also be critical for practices. 

To remain flexible and stable in this transformative time in legislative, billing, and technological advancements, PCPs should continue to:

• Understand your contracts: Whether you’re working with fee-for-service or value-based models, it's important to understand what you're participating in to avoid compliance issues.

• Leverage technology: Certified EHRs and AI-driven tools are becoming essential for ensuring that data is managed correctly and that patient care is seamless and efficient.

• Stay informed: The healthcare landscape is constantly changing, and staying informed about new regulations and policies is critical for ensuring compliance.

2024 and 2025 are set to bring significant changes to healthcare policies and practices. By continuing to understand how policy affects your practice, you can successfully navigate these complexities and continue to provide exceptional care.