Enhancing Primary Care and Cardiology Collaboration Through Payment Reform

In a review published today in JAMA Cardiology, the Duke-Margolis Center for Health Policy and professional societies representing primary care and cardiology describe a conceptual approach to more effective collaboration between cardiology and primary care physicians in treating patients with chronic cardiovascular disease (CVD).

Cardiovascular disease is the leading cause of death in the United States and accounts for 17 percent of national health expenditures. Treating CVD can be challenging for both primary-care and specialized physicians and their patients. The authors argue that these challenges must be addressed through a collaborative approach to delivering CVD care and describe payment reforms that can support effective collaborative care models in a wide range of clinical circumstances. The new approach can clarify clinical roles and responsibilities, improve both the patient and physician experience, as well as health outcomes, while avoiding unnecessary costs.

“This work reflects a special collaboration between the Duke-Margolis Center for Health Policy and professional societies representing primary care and cardiology to address the need for an alternative payment model for collaborative management of chronic cardiovascular disease,” said center director and study co-author Mark McClellan, MD, PhD.

The proposed framework represents broad stakeholder engagement that includes the American College of Cardiology, the American College of Physicians, the American College of Osteopathic Family Physicians, and the American Academy of Family Physicians.

The collaborators propose a set of payment reforms, the core of which could qualify as an advanced alternative payment model under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which rewards physicians who assume greater accountability for quality and cost outcomes. The proposal clearly defines the roles of participating physicians under a payment model where they share responsibility for patient care. While the reforms focus on improving cardiovascular care, they could be adapted for a broad range of chronic health conditions that require primary-specialty care coordination.

“To provide heart disease patients with the best possible care, it is essential that cardiologists and primary care clinicians work effectively together,” said Paul N. Casale, MD, MPH, ACC Board of Trustees member and a member of the U.S. Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee. “This collaborative care framework and payment model offer an opportunity to link clinician roles and responsibilities to payment, thus improving value and the care experience for our patients.”

“Under this consensus proposal, patients would receive higher quality care that supports relationships with their physicians, providers would have improved pathways and support for their shared responsibility for a given patient’s health, and the health care system could benefit from better results and lower costs,” added McClellan.