CMS testing new primary care model in eight states

Key takeaways:

• The new model seeks to enhance the quality and accessibility of care.
• Primary care organizations in participating states may apply to enroll in the program in late summer.

CMS has announced that it is testing a new primary care model through a multistate initiative that aims to strengthen primary care and help providers implement value-based payment arrangements.

The model, Making Care Primary (MCP), “focuses on improving care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists and partnering with community-based organizations, which will help the people we serve with better managing their health conditions and reaching their health goals,” CMS Administrator Chiquita W. Brooks-LaSure said in a press release.

According to CMS, goals of the model are to:

• ensure patients receive primary care that is coordinated, person-centered and accountable;
• create a pathway for practices and organizations — particularly those that are small, independent and in rural locations — to enter value-based payment models; and
• improve patients’ quality of care and health outcomes while reducing expenditures.

To accomplish these, MCP will offer participants additional revenue to support infrastructure that CMS said will “lead to downstream savings over time through better preventive care” and reduce “potentially avoidable costs, such as repeat hospitalizations.” The model is centered around a three-track approach based on the participants’ experience with value-based and alternative payment models. Participants, such as federally qualified health centers and physician practices, in all three tracks will receive enhanced payments.

The first track will focus on building infrastructure to support transformations of care by undergoing risk-stratification of their population, reviewing data and conducting health-related social needs screenings and assessments. Payment in this track will remain fee-for-service (FFS), according to CMS.

The second track will build on the first track by collaborating with social service providers and specialists and screening for behavioral health conditions. The payment model transforms to a 50-50 blend between FFS and population-based payments.

The third and final track will expand upon the first two tracks to build upon workflows, address silos of care and develop specialty-care partnerships. At this stage, the payment model will become fully population based, but CMS will continue to provide financial support.

“Ensuring stability, resiliency, and access to primary care will only improve the health care system,” Liz Fowler, deputy administrator and director of the CMS Innovation Center, said in the release. “The [MCP] Model represents an unprecedented investment in our nation’s primary care network and brings us closer to our goal of reaching 100% of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care arrangements, including advanced primary care, by 2030.”

The program will initially be tested in eight states — Colorado, New Mexico, New Jersey, New York, Minnesota, North Carolina, Massachusetts and Washington — from July 4, 2024, to Dec. 31, 2034.

To be eligible, a primary care organization must be a legal entity formed under state, federal or tribal law in each state it operates, be Medicare-enrolled, bill for health services to a minimum of 125 attributed Medicare beneficiaries and have at least 51% of their primary care sites in an MCP state. Eligible providers can submit an application to participate later this summer, according to CMS.

ACP President Omar T. Atiq, MD, FACP, applauded CMS’ initiative, saying it has the potential “to make progress in solving one of the persistent problems in managing a patient’s care, coordinating across specialties.”

“A well-functioning primary care system is vital to the performance of our overall health care system. Increasing access to primary care medicine is proven to improve health outcomes and lower costs,” Atiq said in a statement. “The [MCP] model aligns with our recommendations and is structured to facilitate and promote care coordination between primary care physicians and other specialists.”

References:

• ACP says new primary care model aligns with recommendations to CMS. http://www.acponline.org/acp-newsroom/acp-says-new-primary-care-model-aligns-with-recommendations-to-cms. Published June 9, 2023. Accessed June 9, 2023.
• CMS announces multi-state initiative to strengthen primary care. https://www.cms.gov/newsroom/press-releases/cms-announces-multi-state-initiative-strengthen-primary-care. Published June 8, 2023. Accessed June 9, 2023.
• Making Care Primary (MCP) model. https://innovation.cms.gov/innovation-models/making-care-primary. Accessed June 9, 2023.