- The CMS announced a new model that aims to strengthen and improve primary care, including by ensuring small and rural organizations are able to enter into value-based care arrangements.
- The Making Care Primary Model will run for more than 10 years in eight states — in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington.
- Research shows primary care is key to improving health outcomes and lowering costs. The CMS noted Medicare and Medicaid patients are often diagnosed with multiple chronic conditions, and primary care providers are charged with prevention, screening and management. But, because many patients will see multiple specialists, coordinating care can be challenging.
Under the MCP Model, participating primary care providers will receive enhanced payments to build up their infrastructure, improve access to care and better coordinate with specialists.
Organizations, including federally qualified health centers, Indian Health Service facilities and tribal clinics, will be divided into three groups based on their experience with value-based care and alternative payments.
In track one, participants will focus on creating infrastructure, like risk-stratifying their populations, finding staff for chronic disease management and conducting social needs screenings. Organizations will continue with fee-for-service payment, and the CMS will provide additional financial support as they build out their capabilities.
Organizations will receive a blend of fee-for-service and prospective, population-based payment in track two as they partner with social service providers and specialists to screen for behavioral health. When participants move to track three, they’ll fully move away from fee-for-service reimbursement while they expand upon work in the previous tracks. The CMS’ additional financial support will decrease as organizations move through each track.
“This model is one more pathway CMS is taking to improve access to care and quality of care, especially to those in rural areas and other underserved populations,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “This model focuses on improving care management and care coordination, equipping primary care clinicians with tools to form partnerships with healthcare 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.”
The model will run for 10 and half years from July next year to the end of 2034. Primary care organizations in participating states can apply for the program late this summer.
MCP builds on previous experiments, including the Comprehensive Primary Care, CPC+ and Primary Care First models, as well as the Maryland Primary Care Program.
A 2018 study published in Health Affairs found CPC reduced emergency department visits, but it didn’t decrease costs overall. An analysis of both CPC and CPC+ from last year in the Journal of General Internal Medicine found slower growth in hospitalizations and ED visits in intervention practices, though Medicare Part A and B expenditures did not change.
The study noted effects on hospitalizations may take longer to emerge, so longer model tests are needed.
Under the MCP, rural health clinics, concierge practices, current PCF organizations, ACO REACH participant providers and grandfathered tribal FQHCs aren’t eligible. Primary care organizations also won’t be able to concurrently participate in the Medicare Shared Savings Program and the new model after the first six months.
“To continue the shift to total cost of care models like ACOs, CMS needs to allow concurrent participation or make comparable options within the Medicare Shared Savings Program to coincide with the start of Making Care Primary,” Clif Gaus, president and CEO of the National Association of ACOs, said in a statement. “In the absence of a population-based payment option for ACOs, practices may choose to move to Making Care Primary rather than remaining in total cost of care models.”