CMS Plans to Test New Primary Care Model in 8 States

The Making Primary Care Model will be tested in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington.

The Centers for Medicare & Medicaid Services (CMS) has announced today a new primary care model that will be tested under the Center for Medicare and Medicaid Innovation in eight states.

Primary care is a fundamental building block of healthcare, including the management of chronic conditions. Access to high-quality primary care is associated with better health outcomes and health equity.

The Making Primary Care (MCP) Model will be tested in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. Primary care organizations in these states will be able to apply for participation in MCP this summer. The model is set to launch July 1, 2024, and it will run through Dec. 31, 2034.

According to CMS, the new primary care model has three goals:

• Provide patients with primary care that is integrated, coordinated, person-centered, and accountable.
   
• Establish a pathway for primary care organizations and practices to enter into value-based care payment arrangements. The focus will be on organizations and practices that are small, independent, rural, and safety net.
   
• Improve care quality and health outcomes while reducing program expenditures.

MCP is designed to improve primary care for Medicare and Medicaid beneficiaries, CMS Administrator Chiquita Brooks-LaSure said in a prepared statement. "This model is one more pathway CMS is taking to improve access to care and quality of care, especially to those in rural areas and other underserved populations. This model focuses on improving care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and partnering with community-based organizations, which will help the people we serve with better managing their health conditions and reaching their health goals."

The new primary care model features three progressive tracks for primary care organizations and practices, according to the MCP webpage.

• Track 1 focuses on 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 (FFS), while CMS provides additional financial support to help participants develop care transformation infrastructure and build advanced care delivery capabilities," the webpage says.
   
• Track 2 focuses on 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," the webpage says.
   
• Track 3 focuses on 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," the webpage says.

Mixed reviews of new model

Jack Resneck Jr., MD, president of the American Medical Association (AMA), praised MCP in a prepared statement.

"We're encouraged to see many of the AMA's recommendations featured in this model including a longer model test, a voluntary, progressive model that meets practices where they are and provides on-ramps for them to advance into prospective payment, and meaningful alignment with Medicaid. The longer test period of 10.5 years directly responds to AMA efforts calling for more transparency and stability to foster trust and encourage physician participation. The AMA strongly believes value-based care models are essential to the long-term wellbeing of the Medicare program and its ability to meet the needs of a diverse and aging population," he said.

The National Association of ACOs (NAACOS) criticized MCP in a prepared statement from President and CEO Clif Gaus, ScD. NAACOS supports investment in primary care, and the organization has proposed a new approach to paying for primary care in the Medicare Shared Savings Program, he said. "The approach we've offered would help CMS meet its stated goal of putting all beneficiaries in a relationship with a provider responsible for total cost of care and quality while increasing investment in primary care."

MCP is counter to these goals by excluding practices that participate in an ACO, he said. "While aspects of the new model are positive, practices should not be forced to choose between Making Care Primary and participating in an ACO. Within ACOs, primary care practices are the quarterback of care teams, but they must work with providers across the care continuum to achieve quality outcomes and cost savings. Working with ACOs has proven to be beneficial to primary care practices, and ACOs with practices concurrently participating in primary care models, such as Primary Care First or the Maryland Primary Care Program, are the most successful."