Primary Care in Medicare Advantage

Its Importance to Hispanic Seniors and Physicians

As a primary care physician, Medicare’s transition to value-based care is especially important to my community and the 55,000 Hispanic physicians I represent. In value-based payment models, primary care physicians work with patients to coordinate their care among various health care providers and across different medical settings. These physicians are rewarded for high quality care and incentivized to improve their patients’ health while reducing costs. The success of value-based care is particularly evident in the Medicare Advantage (MA) program, which covers nearly 40 percent of Hispanic Medicare beneficiaries.

MA’s emphasis on primary and coordinated care is better for both Hispanic seniors and the physicians that care for them. The program’s capitated payment model allows physicians to practice patient-centered care to meet each individual patient’s health care needs and helps build stronger doctor-patient relationships. Physicians are more encouraged to provide preventive services, like screenings, and are often able to catch a patient diagnosis earlier, which avoids more costly care in the future. This is critical to Hispanic seniors because they disproportionately suffer from chronic conditions – such as diabetes and heart disease – and often require secondary prevention to lessen complications with care by medical specialists.

In fact, MA offers chronic conditions special needs plans (C-SNPS) that are designed specifically for seniors with certain, severe chronic diseases.[i] Primary care physicians in MA monitor their patients’ health over time and ensure all health care providers involved in a patient’s care are working together, overseeing everything from routine office visits to post-acute care.

In short, primary care physicians are able to provide health care that is more comprehensive. A recent study by the Annals of Family Medicine found that more comprehensive care among primary care physicians leads to lower Medicare costs and fewer hospitalizations.[ii] While the study was conducted in fee-for-service Medicare, MA has a long history of providing seniors with coordinated, integrated care, which relies on the comprehensiveness and continuity of the doctor-patient relationship. What’s more, other studies have found that seniors in MA experienced fewer hospital admissions and utilized fewer health care services than their fee-for-service counterparts.[iii] [iv] Health care providers in MA share information with one another to ensure each patient is receiving the appropriate care at the right time, while strong quality measures keep physicians accountable for health outcomes.

Last month, the U.S. Hispanic population reached a new high of 55 million.[v] This demographic shift will have a profound impact on our health care system, as more Hispanic Americans age into the Medicare program. Given HHS Secretary Burwell’s recent announcement to move 90 percent of fee-for-service Medicare beneficiaries to value and quality-based care by 2018,[vi] it is likely even more Hispanic beneficiaries will begin to experience the tremendous benefits of care models like MA.

Since 1994, I have been the president and CEO of the National Hispanic Medical Association (NHMA), the leading non-profit association representing Hispanic physicians and health care professionals in the U.S. From the beginning, our goal has been to empower Hispanic physicians and other health care professionals to improve the health of Hispanic Americans and to advocate in Washington for their health and wellbeing. NHMA is proud to be a founding member of the Better Medicare Alliance. We have a shared goal of improving health outcomes for Hispanic beneficiaries and ensuring physicians are able to deliver the best possible care through MA. 

[i] http://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/ChronicCondit...

[ii] http://bettermedicarealliance.org/sites/default/files/Annals-of-Family-M...

[iii] http://archive.ahrq.gov/news/newsletters/research-activities/dec11/1211R...

[iv] https://www.hcup-us.ahrq.gov/reports/statbriefs/sb66.jsp

[v] http://www.pewresearch.org/fact-tank/2015/06/25/u-s-hispanic-population-...

[vi] http://www.hhs.gov/news/press/2015pres/01/20150126a.html