CMS’s Making Care Primary Model Advances Primary Care into Value-Based Care

On June 8, the Centers for Medicare & Medicaid Services announced a new voluntary primary care model – the Making Care Primary (MCP) Model – that will be tested in eight states: Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. The Making Care Primary Model will be tested from July 2024 to the end of 2034. Launching July 1, 2024, the 10.5-year model will improve care management and care coordination, equip primary care clinicians with tools to form partnerships with healthcare specialists and leverage community-based connections to address patients’ health needs as well as their health-related social needs (HRSNs) such as housing and nutrition. CMS is working with state Medicaid agencies in the eight states to engage in full care transformation across payers, with plans to engage private payers in the coming months. CMS will begin accepting applications for the model in late summer 2023. Model Overview The Making Care Primary Model is a 10.5-year multi-payer model with three participation tracks that build upon previous primary care models, such as the Comprehensive Primary Care (CPC), CPC+, and Primary Care First (PCF) models, as well as the Maryland Primary Care Program (MDPCP). MCP aims to improve care for beneficiaries by supporting the delivery of advanced primary care services, which are foundational for a high-performing health system. The MCP Model will provide a pathway for primary care clinicians with varying levels of experience in value-based care to gradually adopt prospective, population-based payments while building infrastructure to improve behavioral health and specialty integration and drive equitable access to care. State Medicaid agencies will commit to designing Medicaid programs to align with MCP in key areas. This model will attempt to strengthen coordination between patients’ primary care clinicians, specialists, social service providers, and behavioral health clinicians, leading to chronic disease prevention, fewer emergency room visits, and better health outcomes. Three Domains Build on New Care Delivery Vision The MCP Model meets primary care organizations where they are through its progressive, three-track approach to begin transforming care and improving outcomes for their patients. This includes several payment innovations to support participants in delivering advanced primary care. To support team-based care, MCP will include prospective payments for primary care that will reduce organizations’ reliance on fee-for-service payments. Risk-adjusted enhanced services payments, which will also be paid prospectively and represent an additional investment in primary care, will allow participants to expand care management, screen for health-related social needs, and integrate with specialty care. MCP will include Federally Qualified Health Centers in a multi-state advanced primary care model for the first time, as well as other organizations serving Medicare beneficiaries with complex health and social needs to further this goal. For these participants, the model features upside-only performance incentives that will allow participants to be rewarded for their work to improve quality and cost outcomes for their patients. The quality performance measures included in MCP reflect the work of CMS to streamline measures across programs and test new innovative measures. The MCP care delivery approach communicates its vision for care delivery through three domains: Care Management: Participants will build their care management and chronic condition self-management support services, placing an emphasis on managing chronic diseases such as diabetes and hypertension, and reducing unnecessary emergency department use and total cost of care. Care Integration: In alignment with CMS’s Specialty Integration Strategy, participants will strengthen their connections with specialty care clinicians while using evidence-based behavioral health screening and evaluation to improve patient care and coordination. Community Connection: Participants will identify and address health-related social needs and connect patients to community support and services. Each of these domains has specific care delivery requirements for participating organizations in each track. Three Tracks Emphasize Value-Based Care Experience MCP’s three progressive tracks are designed to recognize participants’ varying experience in value-based care, from under-resourced participants to those with existing advanced primary care experience in alternative payment models. MCP aims to give these organizations flexibility, allowing them to choose their participation track and receive payments that reflect each participant’s experience towards accountable care. MCP is a three-track model with one track reserved for organizations with no prior value-based care experience. Track 1 – Building Infrastructure: Participants will begin to develop the foundation for implementing advanced primary care services such as risk-stratifying their population, reviewing data, building out workflows, identifying staff for chronic disease management, and conducting health-related social needs screening and referral. Payment for primary care will remain fee for service, while CMS provides additional financial support to help participants develop care transformation infrastructure and build advanced care delivery capabilities. Participants can begin earning financial rewards for improving patient health outcomes in this track. Track 2 – Implementing Advanced Primary Care: As participants progress to Track 2, they will build upon the Track 1 requirements by partnering with social service providers and specialists, implementing care management services, and systematically screening for behavioral health conditions. Payment for primary care will shift to a 50/50 blend of prospective, population-based payments and FFS payments. CMS will continue to provide additional financial support at a lower level than Track 1, as participants continue to build advanced care delivery capabilities. Participants will be able to earn increased financial rewards for improving patient health outcomes. Track 3 – Optimizing Care and Partnerships: In Track 3, participants will expand upon the requirements of Tracks 1 and 2 by using quality improvement frameworks to optimize and improve workflows, address silos to improve care integration, develop social services and specialty care partnerships, and deepen connections to community resources. Payment for primary care will shift to fully prospective, population-based payment while CMS will continue to provide additional financial support, at a lower level than Track 2, to sustain care delivery activities while participants can earn greater financial rewards for improving patient health outcomes. Health Equity Improvement The MCP includes several model components designed to improve health equity: Some payments will be adjusted by clinical indicators and social risk. Participants will be required to develop a strategic plan for how they will identify disparities and reduce them. Participants will be required to implement health-related social needs screening and referrals. Participants will be allowed to reduce cost-sharing for patients in need. CMS will measure the percentage of patients screened for health-related social needs. CMS will collect data on certain demographic information and health-related social needs to evaluate health disparities in MCP communities. Key Reasons for the Model Medicare and Medicaid patients increasingly struggle with multiple chronic diseases, such as diabetes and high blood pressure. Forty percent of Medicare patients see seven or more specialists a year. This makes managing care more complex. As a result, many patients receive fragmented care increasing their likelihood of hospitalization and worse health outcomes. MCP provides primary care clinicians with enhanced model payments, tools, and support to improve the health outcomes of their patients. It provides additional resources and data to help primary care clinicians better coordinate care with specialists. Additionally, it supports better care integration, meaning that clinicians can more seamlessly address physical and behavioral health needs and tap into community networks to reduce health disparities. MCP will aim to ensure that patients receive care to meet their health goals and social needs. Patients will receive enhanced support from MCP participants to better manage their conditions and improve their overall wellness. Download ArticleDownload the Entire Issue

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CMS’s Making Care Primary Model Advances Primary Care into Value-Based Care

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