The Centers for Medicare & Medicaid Services (CMS) aims to advance value-based primary care, especially in rural areas and among underserved populations, with a new pilot project.
The agency announced Thursday a new primary care model will be tested under the Center for Medicare and Medicaid Innovation (CMMI) in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington starting next summer.
The Making Care Primary Model will focus on primary care organizations with limited experience in alternative payment models to help set up the infrastructure, particularly safety net and smaller or independent primary care organizations, CMS officials said in a press release.
The model will kick off July 2024 and participants, which include federally qualified health centers, Indian Health Service facilities and tribal clinics, will receive enhanced payments to shift from fee-for-service payment models and to better coordinate care.
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 health care specialists, and leveraging community-based connections to address patients’ health needs as well as their health-related social needs.
The pilot program will create a pathway for primary care organizations and practices—especially small, independent, rural, and safety net organizations—to enter into value-based care arrangements.
The model also will advance CMS' broader ambitions to boost the adoption of value-based care as a way to improve the quality of care and health outcomes of patients while reducing Medicare and Medicaid expenditures. CMMI has set a goal of having every Medicare beneficiary in a value-based care relationship by 2030.
"CMS expects this work to lead to downstream savings over time through better preventive care and reducing potentially avoidable costs, such as repeat hospitalizations," CMS officials said.
The model will run for 10.5 years, from July 1, 2024, to Dec. 31, 2034 and will build upon previous primary care models, such as the Comprehensive Primary Care (CPC), CPC+, Primary Care First models, and the Maryland Primary Care Program.
“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 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 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.”
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 healthcare access for rural residents. CMS is working with state Medicaid agencies in the eight states to engage in full care transformation across public programs, with plans to engage private payers in the coming months.
The model’s flexible multipayer alignment strategy allows CMS to build on existing state innovations and for all patients served by participating primary care clinicians to benefit from improvements in care delivery, financial investments in primary care, and learning tools and supports under the model, the agency said.
CMS is placing a big bet on value-based care based on the thesis that 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 the costs of care.
The new primary care model will support participants with varying levels of experience with value-based care, including federally qualified health centers and physician practices with limited experience in value-based care.
“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," CMMI Deputy Administrator and Director Liz Fowler said in a statement.
Many provider groups cheered CMS' latest initiative to push value-based primary care.
"Holding primary care physicians accountable for costs and quality is central to achieving the promise of value-based health care. 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," Susan Dentzer, president and CEO of America’s Physician Groups said in a statement.
Dentzer added, "Long-term models such as this one, which will last up to 10 years, will offer stability to participants and may therefore ensure greater participation."
The new model includes many recommendations made by the Americal Medical Association, 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, according to Jack Resneck Jr., M.D., AMA president/
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, he said in a statement.
"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," Resneck said.
The National Association of ACOs (NAACOS), however, pushed back on CMMI's latest effort, saying it will exclude providers who are already in accountable care organizations. forces practices to choose between participating in the model or participating in an accountable care organization.
"While aspects of the new model are positive, practices should not be forced to choose between Making Care Primary and participating in an ACO. 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," said Clif Gaus, president and CEO of NAACOS, 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."
The model includes a progressive three-track approach based on participants’ experience level with value-based care and alternative payment models. Participants in track one will focus 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. This approach will support clinicians across the readiness continuum in their transition to value-based care, furthering CMS’ goal to ensure 100% of traditional Medicare beneficiaries are in a care relationship with accountability for quality and total cost of care.
Primary care organizations within participating states may apply when the application opens in late summer 2023, CMS said.