Excitement, Caution and Unanswered Questions: A Look at CMS’s New Primary Care Models

At the Center for Consumer Engagement in Health Innovation, we’ve long been champions of the important role primary care plays in improving health outcomes, lowering health care costs and achieving health equity. This is especially true for patients with complex health needs, who benefit greatly from the longitudinal relationship and care coordination that primary care professionals often provide. We’ve made improving primary care a top priority of the Center’s 2019-2020 policy agenda, releasing a report on state- and federal-level policy opportunities to improve primary care, and actively engaging with partners who promote primary care as the cornerstone of the health care system.

 

So, we were excited last month when the Center for Medicare and Medicaid Innovation announced they were pursuing new innovative primary care payment and delivery models in Medicare. I was on hand, along with Center Director Ann Hwang, for the big roll out at the American Medical Association late last month where we learned more details about these new models. Primary Care First builds on earlier models that focused on helping primary care practices provide more comprehensive and advanced primary care services such as care coordination, integrated behavioral health care, and attention to patients’ social needs. These earlier models provided practices with small monthly payments for each patient in their practice to account for the extra resources needed to provide comprehensive care and allowed some more advanced practices to reduce their reliance on fee-for-service payments. The Primary Care First model takes this concept further, by increasing the amount of “per patient” payments (payments based on the number and acuity of patients cared for by the practice) and decreasing the component due to “per visit” payments. The total amount of payment to practices will also be adjusted based on their ability to meet certain quality measures and reduce patient hospitalization (this is called a performance-based payment). This model also includes a “seriously ill patients” track that pays practices to provide care coordination to patients with complex health needs who are currently without a primary care provider.