“Not that long ago, primary care practices sold for hundreds of dollars per patient, depending on how ‘fat’ their files were and what proportion were economically undesirable Medicare patients,” Paul A. Branstad and Claude R. Maechling write for Health Affairs. “The principal buyers were hospital-based health care systems that used them for front-line triage and as capture networks for higher-profit, specialist-driven lines of service. Now, suddenly, the likes of Amazon, CVS Health, Walgreens, Walmart, UnitedHeath, and Humana are vying to acquire and build primary care practices targeted at serving the U.S.’s seniors. So far, we estimate they have committed $50 billion, and the competition has driven prices north of $50,000 per patient. When the U.S. finally grasps what is going on, how this competition was triggered in the first place, and what the long-term consequences will be, none of us will like it. Value-based contracts with full-risk capitation payments, mostly Medicare Advantage (M.A.), but also variants of accountable care organization (A.C.O.) models, have grown rapidly to become the majority payment model for Medicare beneficiaries. However, there is no demonstrated proof that these payment arrangements improve the health of beneficiaries more than fee-for-service arrangements. … Such contracts reward ever-increasing scale and will evolve into a competition that only the very largest consumer companies can win. … Too late will we realize we have lost our last best chance to reinvent a health care system centered around the large-scale provision of high-quality primary care — even though this is what value-based contracts started out trying to do. The problem lies not with the Centers for Medicare and Medicaid Services’ (C.M.S.’s) intentions, but with how the game they have structured plays out. An important recent article in the New England Journal of Medicine concludes that the root cause of the $50 billion investment frenzy is the financial opportunity created by C.M.S.’s commitment to convert all Medicare beneficiaries to accountable care relationships with value-based payment models. … Fifty billion may sound like a lot, but it is just table stakes to vie for the $1 trillion prize that McKinsey and Company estimates will be claimed by the winners among the consumer oligopolists competing for the prize.” Paul A. Branstad and Claude R. Maechling, “Explaining corporate America’s aggressive investment In primary care,” Health Affairs.
