CMS launches new primary care model
CMS has announced the launch of a new multi-state primary care model designed to address health equity issues while providing resources for primary care providers to undertake value-based practice transformation.
The Making Care Primary (MCP) Model will run for ten years and be available in 8 states (Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, North Carolina, and Washington) with the aim of building upon previous primary care models, such as CPC+ and Primary Care First (PCF).
“The goal of the Making Care Primary Model is to improve care for people with Medicaid and Medicare,” said CMS Administrator Chiquita Brooks-LaSure in a press release. “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.”
“This model 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.”
Participants will engage in three progressive tracks tailored to the practice’s experience with value-based care and practice transformation:
Track 1 – Building infrastructure
Practices in this track will start to develop the technologies and capabilities to provide advanced primary care services. This includes engaging in risk stratification, conducting health-related social needs screenings and referrals, implementing chronic disease management programming, and optimizing workflows.
Payment in this track will remain fee-for-service, but participants will receive additional financial support from CMS to aid in their development. They will also have the opportunity to start earning incentives tied to health outcomes.
Track 2 – Implementing advanced primary care
This option allows practices to take the next steps toward a more accessible, equitable primary care environment by partnering with social service providers and specialists, enhancing care management services, and systematically screening for behavioral health conditions. The reimbursement in Track 2 will be a 50/50 split between prospective, population-based payments and traditional fee-for-service payments. CMS will offer transformation support at a lower level than Track 1, but offset the reduction with increased opportunities for outcomes-based incentives.
Track 3 – Optimizing care and partnerships
The most advanced track will require practices to use quality improvement frameworks to break down siloes in care with improved workflows and more robust connections throughout the care continuum. Payment will be fully value-based, although some additional developmental support will be available. This track offers the greatest potential for rewards based on health outcomes.
Health equity will be a strong focus throughout the model, CMS says. Participants will be required to develop a strategic health equity plan that must include specific steps for identifying and addressing common health-related social needs via screenings and community-based partnerships.
CMS will collect data on certain demographic elements and health-related social needs to evaluate health disparities in participants’ communities. This information will be used to adjust some payments by clinical indicators and social risk, the agency said.
Most primary care providers in the eight participating states will be eligible to join MCP, but there are some notable exceptions and caveats. Current Primary Care First (PCF) practices and ACO REACH Participant Providers are not eligible. And organizations will not be able to concurrently participate in the Medicare Shared Savings Program and MCP after the first six months of the model.
Practices will need to carefully evaluate the financial, clinical, and community benefits of choosing MCP over other existing value-based care options before applying for the new program.
“Ensuring stability, resiliency, and access to primary care will only improve the health care system,” said CMS Deputy Administrator and Center for Medicare and Medicaid Innovation Director Liz Fowler.
“The Making Care Primary 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.”
CMS plans to publish a Request for Applications later in the summer of 2023, and will provide more details about the model’s design in the near future, including how MCP will align with state Medicaid programs to reach as many patients as possible.
Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system. She can be reached at email@example.com.