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News and Updates
April 30, 2019
Multi-Payer Primary Care Transformation
On April 22, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced a new set of payment models for primary care—”Primary Care First.” The models expand CMS’s commitment to multi-payer primary care transformation—extending its Comprehensive Primary Care Plus (CPC+) program to more markets and more primary care providers with a third payment track.
Primary Care First gives primary care physicians a new payment option with a mix of per capita and fee-for-service payments, financial accountability, and opportunity for achieving improved patient outcomes. It also gives providers in this track tools and payment mechanisms to enable them to better care for high need, seriously ill patients.
The new program is designed to accelerate and sustain Medicare’s commitment to increased support for primary care, acknowledging it to be the foundation of a high-performing health system. Providers and payers in 18 CPC+ regions will be able to apply to participate. Eight other states not currently in the CPC program have been added—Alaska, California, Delaware, Florida, Maine, Massachusetts, New Hampshire, and Virginia. The model, which launches in January 2020, will be tested for five years.
“Primary Care First is an effort by CMS to build and expand upon many of the efforts that came before it. It shines a spotlight on primary care—and its central role in improving population health and grappling with health care costs,” says Lisa Dulsky Watkins, the Fund’s Multi-State Collaborative director.
CPC+, Medicare’s largest and most ambitious multi-payer primary care transformation program, is halfway into its five-year test. A report on the CPC+’s first year of implementation was released last week. Evaluators from Mathematica Policy Research assessed the findings—and noted that, in its first year, CPC+ substantially supported participating primary care practices as providers pursued the desired care delivery transformation. The intent is that Primary Care First will capitalize on the infrastructure created by the CPC+ and further its success.
While many details are yet to come, the Primary Care First model has been described as an opportunity for physicians to earn significantly more money for improving the value of the care their patients receive. Recognizing that small, independent practices need a steady stream of income to do their work well, the model provides an up-front monthly per-patient payment, a simplified per-visit billing and payment process, and a potential bonus up to 50% of physician payments, based on improvements in inpatient admission rates and satisfactory quality performance. Physicians also could potentially lose 10% of their income based on the same performance measure. In addition, there will be a supplemental payment option for practices that care for the most complex patients requiring resource-consuming coordinated care.
As with CPC+ and its predecessor, CPC Classic, the Primary Care First payment model will be multi-payer in design. While CMS is recruiting physicians in the 26 markets to sign up for the scheduled January 2020 start, it will also be soliciting commitments from the insurers already committed to CPC+ and additional payers to align their payment models and transformation activities with the Primary Care first model.
“This deepens the Innovation Center’s commitment to primary care, keeping it at the center of far-reaching experiments,” said Dulsky Watkins. “We will continue to work hard with our colleagues at CMS and especially with the committed health plans and the conveners who work with them in the participating markets to promote payer alignment to build a strong primary care-based delivery system. We will need to actively leverage the strong working relationships of our collaborative in this next phase.”
Read CMS’ full press release, with links to more specific information, here.
The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evidence and experience.
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