CMS Unveils Pilot Program to Enhance Primary Care Services

CMS Unveils Pilot Program to Enhance Primary Care Services

The program will begin in eight states.

How do you make primary care better? Why, by making care primary, of course.

Such was clearly the thinking behind at least the branding of the Making Care Primary (MCP) Model introduced this week by the Centers for Medicare & Medicaid Services (CMS), which described it as a pilot program being managed by the Center for Medicare and Medicaid Innovation, initially in eight select states.

“Access to high-quality primary care is associated with better health outcomes and equity for people and communities,” CMS said in a press release. “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. The model seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary-care clinicians with tools to form partnerships with healthcare specialists, and leveraging community-based connections to address patients’ health needs as well as their health-related social needs.”

CMS laid out three goals for the pilot: one, to ensure that patients receive primary care that is “integrated, coordinated, person-centered and accountable”; two, to create a pathway for primary-care organizations and practices – especially small, independent, rural, and safety-net organizations – to enter into value-based care arrangements; and lastly, to improve the quality of care and health outcomes of patients while reducing program expenditures.

Officials said that MCP will provide participants with additional revenue to build infrastructure, make primary-care services more accessible, and better coordinate care with specialists. CMS also said it anticipates the program will “lead to downstream savings over time through better preventive care and reducing potentially avoidable costs, such as repeat hospitalizations.”

The pilot will run for a little more than a decade, from July 1, 2024, to Dec. 31, 2034 – building upon previous models such as the Comprehensive Primary Care (CPC), CPC+, Primary Care First models, and the Maryland Primary Care Program (MDPCP) – and initially run in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington.

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

CMS said it will work with model participants to address priorities specific to their communities, including care management for chronic conditions, behavioral health services, and care access for rural residents. Officials said they are working with Medicaid agencies in the eight pilot states to “engage in full care transformation across public programs, with plans to engage private payers in the coming months.” The pilot features a flexible multi-payor alignment strategy CMS said will allow it to build on existing state innovations for all patients served by participating primary-care clinicians to benefit from improvements in care delivery, financial investments, and learning tools and resources.

“Primary-care clinicians provide preventive services, help manage chronic conditions, and coordinate care with other clinicians,” CMS said in its press release. “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. This model will support participants with varying levels of experience with value-based care, including Federally Qualified Health Centers (FQHCs) and physician practices with limited experience in value-based care, as CMS continues to work to reduce disparities in care and drive better patient experience and outcomes.”

“Ensuring stability, resiliency, and access to primary care will only improve the healthcare system,” CMS Deputy Administrator and Center for Medicare and Medicaid Innovation Director Liz Fowler added in a statement. “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.”

Officials went on to describe a “progressive three-track approach” based on participants’ experience level with value-based care and alternative payment models. Participants, including FQHCs, Indian Health Service facilities, and Tribal clinics, among others, in all three tracks will receive enhanced payments, with participants in Track One focusing on building infrastructure to support care transformation. In Tracks Two and Three, the model will include certain advance payments and will offer more opportunities for bonus payments, based on participant performance.

Primary-care organizations within participating states can apply to join as soon as the application opens in late summer 2023, and the model will launch on July 1, 2024.

To view a website CMS has created for the MCP pilot, go online to https://innovation.cms.gov/innovation-models/making-care-primary

To view a video featuring key highlights of the program, go to https://youtu.be/8vy3PHHlCe4.

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Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade.

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