CMS announces new primary care initiative
Two tracks are recommended: a monthly care management fee from CMS in addition to fee-for-service payments under the Medicare Physician Fee Schedule, or a monthly care management fee and a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments.
CMS last week announced the creation of a new 2-track primary care initiative.
The Comprehensive Primary Care Plus model will be implemented in 20 U.S. regions and can accommodate 5,000 practices, the agency said in a press release.
Primary care practices participating in the model will choose 1 of 2 tracks. Those in track 1 will receive a monthly care management fee from CMS in addition to fee-for-service payments under the Medicare Physician Fee Schedule. Those in track 2 will also receive a monthly care management fee and a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments. CMS said that the hybrid payment design “will allow greater flexibility in how practices deliver care outside of the traditional face-to-face model.” Practices in both tracks will receive incentive payments upfront that they will then keep or repay based on quality and utilization metrics.
As part of the new model, CMS said, Medicare will partner with insurance plans to support delivery of “advanced primary care,” which involves the following 5 components:
- Services are accessible and responsive to an individual's preference, and patients can take advantage of enhanced in-person hours and 24/7 telephone or electronic access.
- Patients at highest risk receive proactive, relationship-based care management services to improve outcomes.
- Care is comprehensive, and practices can meet the majority of each individual's physical and mental health care needs, including prevention. Care is also coordinated across the health care system, including specialty care and community services, and patients receive timely follow-up after ED or hospital visits.
- It is patient-centered, recognizing that patients and family members are core members of the care team, and actively engages patients to design care that best meets their needs.
- Quality and utilization of services are measured, and data are analyzed to identify opportunities for improvements in care and to develop new capabilities.
Participating regions will be selected by CMS where interest from multiple payers is sufficient to support practices' participation. Payer proposals to partner in the new Comprehensive Primary Care Plus model will be accepted from April 15 through June 1, and practice applications in the designated regions will be accepted from July 15 through Sept. 1. A fact sheet on the Comprehensive Primary Care Plus model is available online.
In a statement, ACP's President, Wayne J. Riley, MD, MPH, MBA, MACP, said that ACP believes the new initiative offers the potential to greatly strengthen the ability of primary care clinicians to deliver high-value, high-performing, effective, and accessible primary care. Dr. Riley said the College is encouraged by the availability of 2 different tracks and strongly supports the goal of ensuring that all participating practices will be able to build capabilities and care processes to deliver improved care.
“The success of the Comprehensive Primary Care Plus program will depend on Medicare and other payers providing physicians and their practices with the sustained financial support needed for them to meet the goal of providing comprehensive, high value, accessible, and patient-centered care, with realistic and achievable ways to assess each practices' impact on patient care,” Dr. Riley stated. “The College is committed to working with CMS on the details of implementation to ensure that the program is truly able to meet such requirements of success.”