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CMS Announces 5 New Advanced Primary Care Payment Models

Summary

CMS announced the new CMS Primary Cares Initiative, comprising 5 new payment models under 2 programs, which will test the impact of providing considerable financial incentives and flexibility to primary care practices and organizations in exchange for significant provider risk.

The Primary Care First (PCF) demonstration will be aimed at primary care practices, while the Direct Contracting (DC) model is geared toward organizations with experience providing coordinated care and assuming financial risk.

Highlights

  • PCF is a 5-year, multipayer demonstration that will begin in January 2020 and build on the Comprehensive Primary Care Plus demonstration. PCF will initially be offered in 26 regions.
  • PCF will provide primary-care practices with experience in value-based care monthly population-based payments (PBPs), a flat primary-care visit fee, and the opportunity to earn performance-based payment adjustments. PCF also includes an option for practices to care for seriously ill beneficiaries without a primary-care provider.
  • DC is a 6-year demonstration that will begin in January 2020 but with the first performance year occurring in 2021.
  • DC comprises 3 payment model options that will provide prospective, capitated payments to organizations: (1) the Professional PBP track provides payment for enhanced primary care services; (2) the Global PBP track provides payment for all services provided by track participants; and (3) the Geographic PBP will require participants to assume financial responsibility for the total cost of care for all Medicare fee-for-service (FFS) beneficiaries in a defined geographic region. CMS issued a Request for Information on the Geographic PBP option to further define the parameters of this DC payment model.
  • CMS believes the Primary Cares Initiative could cover as much as 25% of Medicare FFS beneficiaries and provide new payment model options for 25% of primary-care practitioners.

“CMS is seeking to transform primary care and the patients’ relationship with provider organizations by offering value-based payments to participating providers in exchange for increased provider accountability for costs and outcomes,” said John Feore, associate principal at Avalere. “The Primary Cares Initiative offers primary care practices multiple pathways to assume greater financial risk in return for flexibility in care delivery.”

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