CMS is testing new primary care model

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The Centers for Medicare and Medicaid Innovation is testing a new primary care model in eight states.

The Making Care Primary (MCP) Model includes enhanced payments in three tracks. 

Participants, which include Federally-Qualified Health Centers, Indian Health Service facilities and Tribal clinics, among others, in all three tracks will receive enhanced payments to build infrastructure, make primary care services more accessible and better coordinate care with specialists. 

CMS expects this work to lead to downstream savings over time through better preventive care and reducing potentially avoidable costs, such as repeat hospitalizations. Participants in Track One will focus on building infrastructure to support care transformation, CMS said. 

In Tracks Two and Three, the model will include certain advance payments and will offer more opportunities for bonus payments based on participant performance. This approach will support clinicians across the readiness continuum in their transition to value-based care, CMS said. 

CMS will test this advanced primary care model in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington. CMS is working with State Medicaid Agencies in the eight states to engage in full care transformation across public programs. It has plans to engage private payers in the coming months. The model's flexible multi-payer alignment strategy allows CMS to build on existing state innovations.

Primary care organizations within participating states may apply when the application opens in late summer 2023. The model will launch on July 1, 2024 and run through December 31, 2034.

It will build upon previous primary care models, such as the Comprehensive Primary Care, CPC+, Primary Care First models and the Maryland Primary Care Program (MDPCP).

WHY THIS MATTERS

The MCP model will expand and enhance care management and care coordination by equipping primary care clinicians with tools to form partnerships with healthcare specialists and leverage community-based connections to address patients' health and health-related social needs, the Centers for Medicare and Medicaid Services said. 

The model is furthering CMS's goal to ensure 100% of traditional Medicare beneficiaries are in a care relationship with accountability for quality and total cost of care. 

Access to high-quality primary care is associated with better health outcomes and equity for people and communities, CMS said. MCP is an important step in strengthening the primary care infrastructure in the country, especially for safety net and smaller or independent primary care organizations. 
CMS said it would work with model participants to address priorities specific to their communities, including care management for chronic conditions, behavioral health services and healthcare access for rural residents. 

However, NAACOS, the National Association of Accountable Care, voiced concern that the Making Care Primary Model excludes practices that are part of an ACO.

"While aspects of the new model are positive, practices should not be forced to choose between Making Care Primary and participating in an ACO," said Clif Gaus, president and CEO of the National Association of ACOs. "Within ACOs, primary care practices are the quarterback of care teams, but they must work with providers across the care continuum to achieve quality outcomes and cost savings. Working with ACOs has proven to be beneficial to primary care practices, and ACOs with practices concurrently participating in primary care models, such as Primary Care First or the Maryland Primary Care Program, are the most successful."

NAACOS has previously called for CMS to establish an option for ACOs to implement population-based payments for primary care. 

"The approach we've offered would help CMS meet its stated goal of putting all beneficiaries in a relationship with a provider responsible for total cost of care and quality while increasing investment in primary care," Gaus said.

NAACOS said that CMS needs to allow for concurrent ACO participation or make comparable options within the Medicare Shared Savings Program to coincide with the start of Making Care Primary. 

"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," Gaus said.

Susan Dentzer, president and CEO, America's Physician Groups, praised CMS for the launch of the long-term model that she said would offer stability and therefore greater participation.

"Holding primary care physicians accountable for costs and quality is central to achieving the promise of value-based healthcare," Dentzer said. It's therefore important to continue to provide accessible 'on ramps' for small practices to enable them to make what could otherwise be a difficult transition for them. We at APG are especially excited that Track 1 of the model is explicitly designed for federally qualified health centers, which serve some of the nation's most vulnerable patients. The model seeks to align payment across Medicare, Medicaid, and commercial payment where possible. These approaches are also vital to stimulating the spread of value-based care." 

American Medical Association President Dr. Jack Resneck Jr. said,"We're encouraged to see many of the AMA's recommendations featured in this model including a longer model test, a voluntary, progressive model that meets practices where they are and provides on-ramps for them to advance into prospective payment, and meaningful alignment with Medicaid. The longer test period of 10.5 years directly responds to AMA efforts calling for more transparency and stability to foster trust and encourage physician participation. The AMA strongly believes value-based care models are essential to the long-term wellbeing of the Medicare program and its ability to meet the needs of a diverse and aging population. We appreciate the Administration's ongoing work to improve patients' equitable access to care and look forward to reviewing the details of the model when they become available."

THE LARGER TREND 

Strong relationships with primary care teams are essential for patients' overall health, CMS said. Primary care clinicians provide preventive services, help manage chronic conditions, and coordinate care with other clinicians. By investing in care integration and care management capabilities, primary care teams will be better equipped to address chronic disease and lessen the likelihood of emergency department visits and acute care stays, ultimately lowering costs of care. 

ON THE RECORD 

"The goal of the Making Care Primary Model is to improve care for people with Medicaid and Medicare," said CMS Administrator Chiquita Brooks-LaSure. "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."

"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."

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org