BrightSpring Health Services / January 10, 2023
BrightSpring is pleased to announce that its Home-Based Primary Care business, Western Reserve Medical Group, selected for participation in the Centers for Medicare and Medicaid Services’ (CMS) most advanced primary care payment model, Primary Care First, has successfully completed its first year of participation. The practice, which provides comprehensive primary and palliative care services to complex patients in Ohio and Kentucky, is one of less than 3,000 groups across the country selected to participate. The model utilizes a risk-based, capitated payment methodology and patient-centered outcome quality payments to help transform primary care towards a pay-for-value system.
Belinda Schraer, chief operating officer of the practice, said, “We are pleased that we have completed year one of participation in Primary Care First (PCF). During 2022, we saw our PCF census grow by 20%, and we gained additional insight into our person-centered home-based primary care model by way of PCF’s data tools. We look forward to continuing our positive momentum and growth of our PCF program in 2023.”
William Mills, M.D., senior vice president of medical affairs for BrightSpring and founder of the group, said, “Through our participation in PCF in 2022, our home-based primary care practice demonstrated exceptional quality and cost-effectiveness outcomes. During the year, we saw a 39% decrease in risk-adjusted ambulatory care sensitive conditions discharges to 13.07, compared to the regional average rate of 26.73 per 1,000 beneficiary years. The CMS data also showed that the group’s all-cause readmission rate decreased by 38% to 0.57 (risk-adjusted observed-to-expected ratio), which is 16% lower than the regional readmission rate. We are also very pleased that while our patients enjoy the convenience of full-service, expert medical care within their homes and senior living communities, that our group delivers this care extremely cost-effectively. In 2022, the practice’s risk-adjusted, per beneficiary per month total Medicare expenditures were $1,176, compared to the region’s average of $2,128 per beneficiary per month.”
Mills continued, “We look forward to continuing to help patients achieve high-quality, goal-directed care at home as part of the program. We are especially excited that CMS included outcomes measures such as hospitalization rate, advance care planning, days spent at home, and patient satisfaction as outcome measures, as we believe that these are important measures not just to payers – but are also centrally important to patients and families. We are especially eager to increasingly utilize the unique clinical, caregiver and pharmacy network that exists within BrightSpring to deliver more comprehensive medical and support services into the homes of patients in need, and we look forward to growing our footprint into other geographies in the coming months.”
“It is also exciting that other payer partners, such as Aetna, Humana and Ohio Medicaid have also agreed to participate in this population-based payment model, and we look forward to working with payers on this high-value care model,” said Schraer. “It is our hope that Primary Care First encourages even more payers to engage home-based medical groups like ours in value-based care payment models so that more patients in need can receive 21st-century medical house calls in the comfort of their homes.”