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Care Coordination and Primary Care

Original Medicare, with its fee-for-service payment system, often fails to bring high quality coordinated care to people with complex healthcare needs. It also can shortchange the American taxpayer who too often pays for unnecessary and sometimes harmful services simply because there is no single medical professional coordinating patient care. The fragmentation of U.S. healthcare delivery leaves too many Medicare eligible Americans without the single physician (sometimes called a "medical home") monitoring and coordinating safe care.

Our Position

  • Patients receive the best care when their doctors have the authority, tools, and the incentives to serve their patients. For instance, Universal American works with Primary Care Physicians to select specialty networks that are coordinated by the primary care doctor. Universal American then supports its physicians with well executed medical management services, providing financial, utilization, patient satisfaction and clinical data to the doctors for the benefit of their patients. Universal American supports care coordination and applauds the steps taken in PPACA to promote care management practices similar to those we have long employed.
  • The United States’ healthcare system must adopt a model of coordinated care that changes the role of a primary care doctor from "exam room" quality to "total patient outcome" quality. Primary Care Physicians in our network plans are paid not just for what they do in the exam room; they are paid to coordinate care so their patients can achieve the best possible health outcomes. Universal American believes the encouragement of Medical Homes in PPACA is sound public policy and validates many of our current practices in our Medicare Advantage health plans.
  • A Primary Care Physician, whether he or she be an internist, a family doctor or a geriatrician, is essential to care coordination for people with Medicare. But the Primary Care Physician in America is disappearing. Only 4% of current medical students intend to be Primary Care Physician. Universal American strongly believes that the U.S. needs more Primary Care Physicians. Incentives are needed that provide bundled compensation for doctors who give high quality coordinated care in a medical home setting, and tuition debt forgiveness is needed for physicians who enter and stay in a primary care practice. Medicare should lead the way in increasing the compensation for these critical professionals.