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INDUSTRY WATCH Policy & Value-Based Care


New HHS Models Seek to Shift Primary Care to Value-Based Payments


The U.S. Department of Health and Human Services announced on April 22 a new set of voluntary value-based payment models for primary care physicians under the label “Primary Cares.” Adam Boehler, director of the CMS Innova- tion Center, called it “a clear sign that we are changing the status quo. These are sweeping models that will shift one-quarter of this country to outcomes- based payment. It is time to dismantle the old, broken fee-for-service system that we have today and replace with one that pays for outcomes and quality.” Speaking at a press conference at the American Medical Association offices in


Washington, D.C., Boehler stressed that a strong focus on primary care is essen- tial to an effective healthcare system broadly. “Despite being only 2 to 3 percent of spend, primary care providers have an enormous influence over downstream costs,” he explained. “Our current payment systems do not recognize the central role primary care providers play. We are going to change that today.” The newly announced effort has two prongs: The Primary Care First Initiative creates an opportunity for providers to leave behind fee for service and be paid for keeping their patients healthy and at home. The second is Direct Contracting, which allows sophisticated organizations to take full accountability for their pa- tients at a local level. Both paths are voluntary and they emphasize a focus on complex, high-needs patients, Boehler said. He then described the details and timelines. The Primary Care First Initiative is made up of two model options. Both options


allow physicians to move away from fee for service and potentially eliminate their revenue cycle operations, he said. “CMS will make monthly population-based payments along with a simple, flat primary care visit each time a provider sees a patient. Providers will be eligible for significant payments if their patients stay healthy and at home. There is downside risk of 10 percent, which is about the equivalent of the revenue cycle cost today, he noted. “There is an asymmetri- cally upside potential of 50 percent. The performance will be measured on risk- adjusted hospitalizations. For example, doctors who earn $200,000 today could earn up to $300,000 if their patients stay healthy at home,” Boehler added. “This model is scheduled to be in January 2020, and we expect to release a request for applications in the next few months.”


Direct Contracting creates multiple payment options for providers to take risks and earn rewards based on quality outcomes. “This model improves on prior efforts, including Next Generation ACOs, and they are tailored for larger organiza- tions that have experience taking accountability,” Boehler said. The first option is called the Professional option: This offers providers the op-


portunity to share in 50 percent of the savings and the losses on risk-adjusted total cost of care, Boehler said. Providers in this option will receive predictable monthly payments for enhanced primary care services. The second option is the Global option: “This will offer providers the opportunity to take full 100 percent accountability for savings and losses,” he added. “Providers will also receive pre- dictable monthly payments for primary care services or monthly payment for all healthcare services if they chose to pay claims.” Both Primary Care First and Direct Contracting focus on complex, chronic and seriously ill patients. They support approaches such as home-based models dedicated to serving this patient set. He said the efforts draw from hot-spotting models and from proposals form the Physician-Focused Payment Model Techni- cal Advisory Committee (PTAC), as well as the American Academy of Hospice and Palliative Medicine, the Coalition to Transform Advanced Care, and the American Academy of Family Physicians. “It is time that we empower providers so that they can focus on patients,” Boehler said. “This is why providers went to medical school in the first place. It is time that we put patients in the driver’s seat, so that providers can compete for their loyalty through a combination of service, price and overall experience. When you pay for quality outcomes instead of volume, you transform a health- care system that caters to special interests into a market-based system in which providers compete for the right to take care of each patient. The patient is the empowered consumer.”


4 4 hcinnovationgroup.com | MAY/JUNE 2019 Imaging


Radiologists Creating Their Own AI Algorithms? A New Partner- ship Provides the Opportunity


Artificial intelligence (AI) computing company NVIDIA and the American College of Radiology (ACR) are collaborating to make an AI-based toolkit available for radiologists to build, share, locally adapt and validate AI algorithms. Following a three-month pilot program by both


parties, ACR is integrating the NVIDIA Clara AI toolkit into the newly announced ACR Data Science Insti- tute ACR AI-LAB, which is a free software platform that will be made available to more than 38,000 ACR members and other radiology professionals to develop and authenticate AI algorithms, while also ensuring patient data stays protected at the local institution, according to officials who made the an- nouncement at the World Medical Innovation Forum 2019 in Boston.


The pilot with the Ohio State University (OSU) and the Massachusetts General Hospital and Brigham and Women’s Hospital’s Center for Clinical Data Sci- ence (CCDS) helped NVIDIA and ACR define the as- sets and pathways necessary to enable facilities to work together and with industry to refine AI algo- rithms without sharing potentially sensitive patient data, officials stated in a press release. “Bringing an AI model to the patient data, instead of patient data to the model, can help increase diversity in algo- rithm training, facilitate validation of the algorithms and enable radiologists to learn the steps needed to adapt algorithms to their institutions’ clinical needs,” they said.


Specifically, using the NVIDIA Clara AI toolkit, OSU professionals were able to quickly import a pre- trained model developed by CCDS. This model was customized to local variables and successfully la- beled OSU data for further testing and improvement of the algorithm, all of which took place behind their own firewall. It resulted in an accurate and enhanced cardiac computed tomography angiography model, and the shared approach reduced algorithm training, validation and testing times by days, officials noted. “This software will offer radiologists, without computer programming experience, the ability to build and improve AI algorithms without the need to share their data,” said Keith Dreyer, D.O., Ph.D., chief data science officer at Partners HealthCare and associate professor of radiology at Harvard Medical School. Partners HealthCare also has announced that CCDS is planning broad roll-out to the Partners sys- tem over the next 12 months, and is already offering AI capabilities and support service. “The truth is, you don’t have to be a computer scientist or data scien- tist to participate in the creation of AI—we are just starting to see increasing availability of tools to en- able on-premises development of AI models by clini- cians,” said Dreyer.


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