The Department of Health and Human Services (HHS) and Medicare & Medicaid Services (CMS) delivered news of the CMS Primary Cares Initiative, a new set of payment models the agencies said will “transform primary care to deliver better value for patients throughout the healthcare system.”
In a joint statement, HHS Secretary Alex Azar amd CMS Administrator Seem Verma said the CMS Primary Care Initiative, developed by the Innovation Center, is designed to reduce administrative burdens enough to give providers back the time they need to care for patients. The move is also supposed cut overall healthcare costs. “For years, policymakers have talked about building an American healthcare system that focuses on primary care, pays for value, and places the patient at the center. These new models represent the biggest step ever taken toward that vision,” said HHS Secretary Alex Azar in the announcement.
HHS pointed to empirical evidence which indicates strengthening primary care is associated with higher quality, better outcomes, and lower costs within and across major population subgroups. However, the agency said primary care spending accounts for a small portion of total cost of care, and is even lower for patients with complex, chronic conditions. For many patients, the primary care clinician is the first point of contact with the healthcare delivery system and history shows that aligning incentives for primary care clinicians that reward high value-care, the quality and cost effectiveness of patient care improves.
Administered through the CMS Innovation Center, the CMS Primary Cares Initiative will provide primary care practices and other providers with five new payment model options under two paths: Primary Care First and Direct Contracting. Among the the five payment model options, PCFs will apply to individual primary care practice sites and DC models are available to providers that can handle greater financial risk and provide care to larger patient populations (e.g., Medicare Advantage plans, Medicaid managed care organizations, accountable care organizations,etc.).
“For years, our members have demonstrated that patient-centered, integrated, and accountable care can address the low-quality, high-cost care that comes with a fragmented fee-for-service healthcare system,” said Don Crane, President and CEO America’s Physician Groups. “We’re very pleased to see that many of our recommendations for improving value-based care were adopted throughout these new models.”
Visit CMS for specific details on the above models.
Together, CMS anticipates the five payment model options administered under the Primary Cares Initiative could:
· Provide better alignment for over 25 percent of all Medicare FFS beneficiaries – nearly 11 million Medicare beneficiaries would potentially be included (a collective 5 million beneficiaries in the DC payment model options and a collective 6.4 million in PCF payment model options);
· Offer new participation and payment options and opportunities for an estimated one in four (25 percent) primary care practitioners as well as other health care providers; and
· Create new coordinated care opportunities for a large portion of the 11-12 million beneficiaries dually eligible for Medicare and Medicaid, specifically those in Medicaid managed care and Medicare FFS.
HHS said all model options focus on supporting care for patients who have chronic conditions and serious illnesses. Through the PCF payment model options, high need patients with serious illness who do not have a primary care practitioner or care coordination and indicate an interest in receiving care from a practice participating in the model will be assigned to a model participant. Participating practices that choose to care for SIP patients will be required to provide care to clinically stabilize the patient. All payment model options include enhancements to encourage participation of providers who are focused on care for these populations.
