Should health care policy leaders worry about the massive investments being made by corporate interests in US primary care? A team of health policy researchers think they should.write in New England Journal of Medicine Online on Jan. 7 in a Perspectives op-ed article “Primary Care Corporate Investors—Profits, Progress, and Pitfalls” Soleil Shah, M.Sc., Hayden Rooke-Ley, and Erin C. Fuse Brown, JD, MPH, Medicare beneficiaries enrolled in a Medicare Advantage Plan or assigned to a Medicare ACO (Accountable Care Organization) However, if companies benefit from certain aspects of their investment trends in primary care, the associated patterns of investment can have adverse effects on health equity and access. Researchers are affiliated with the Stanford University School of Medicine and Stanford Law School, Center for Law, Health and Society, and Georgia State University Law School.
The author of the article writes: If the deal is approved, it would be Amazon’s largest payment to a healthcare company to date. On September 5, 2022, CVS Health confirmed it had acquired Signify Health, a home and conventional primary care provider, for approximately $8 billion. These deals reflect a broader U.S. trend toward corporate investment in primary care, fueling interest in “total cost value-based care,” a model in which healthcare providers are paid to manage. This is due to the rising The total cost of patient care and the size of each patient’s head budget may increase based on the performance of providers on patient health risks and quality indicators. While this may be beneficial for certain well-insured patients, trends in corporate investment in primary care threaten equitable access to care, raise health care costs, and reduce physician clinical “Physicians, patients, and policy makers need to understand the drivers of these investments, the potential benefits and risks, and possible policy measures to mitigate those risks.” is needed.”
The researchers stress that while “corporate interest in primary care practices is nothing new,” they are deeply concerned about:[T]The recent pace of investment is noteworthy. Between 2010 and 2021, total capital raised for private investment in U.S. primary care increased more than 1,000-fold, from $15 million to $16 billion. And they wrote that there are notable complexities in both retail-owned and corporate-owned “corporate-owned primary care practices” (PCPs). . Examples: Agilon Health, Oak Street Health). Many CPCPs fit into multiple categories. For example, Oak Street’s early investors included Humana and a private equity firm that established a partnership with Walmart after going public. The CPCP organizational structure varies depending on the target market segment or payment model (e.g. Medicare Advantage, Medicare, or Private Accountable Care Organization) [ACOs]or direct contract under the new ACO to achieve equity, access and community health [REACH] model), but they all benefit from increasing the risk-adjusted payout they receive by engaging in more focused and strategic risk coding, and have the market incentives to do so. may also have resources, such as proprietary coding software, robust beneficiary data, and additional administrative staff, that facilitate focused coding practices that are often not available to independent primary care physicians. ”
Importantly, the authors of the article write, the continued growth of the Medicare Advantage market, which already accounts for nearly half of Medicare spending, is attracting corporate investors to primary care practices.
The researcher wrote: Federal and state enforcers can extend antitrust scrutiny to these transactions to identify threats to competition. The Federal Trade Commission is considering the Amazon-CVS deal, but may also evaluate smaller, staged acquisitions of physician practices and trades across multiple geographic and product markets. Importantly, they noted, “Medicare and Medicaid Service centers limit opportunities to exploit risk-coding systems that determine Medicare Advantage payments, and extra public funds are spent on coding work rather than improving care.” You can prevent it from being broken,” he claims. Ultimately, the risks associated with corporate investment in primary care must be carefully considered by policy makers to ensure outcomes consistent with improved equity and access, rather than vice versa. .
