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Analysis

CMS Delays Primary Care First Model Rollout to 2021

By Steven Porter  
   October 25, 2019

CMS says the additional time will be used to evaluate stakeholder feedback.

Six months after announcing new value-based payment models to transform primary care, the Centers for Medicare & Medicaid Services released a request for applications (RFA) on Thursday that details how healthcare providers in certain areas and regions can apply to participate in one of the Primary Care First (PCF) model options.

Although CMS had earlier indicated plans to launch the first five-year PCF cohort in January 2020, the RFA indicates that the first round has been delayed a full year, until January 2021.

The Center for Medicare & Medicaid Innovation (CMMI), which manages the agency's experimental payment models, didn't immediately cite a reason for the delay. However, a CMS spokesperson said Friday the extra time would be used to evaluate "internal and external feedback from all stakeholders."

"We are committed to ensuring that the Primary Care First application incorporates this critical feedback in response to the model's announcement in April," the CMS spokesperson said.

"CMS moved the start date to allow stakeholders more time to consider participation, a decision that requires practices to assume risk in exchange for outcomes-based rewards. The delay also helps practices prepare for participation by allowing them additional time to move away from a fee-for-services structure," the spokesperson said.

Some stakeholders have touted the PCF and Direct Contracting (DC) model options that CMS outlined last spring as potentially poised to usher in a new wave of consumer-centric competition that could kickstart value-based care in Medicare and beyond. But they have been waiting for the RFA to assess key details, including how benchmarks will be established and calculated, how risk adjustment will work, and what waivers CMS will allow.

The DC model options are also expected to begin in January 2021, according to the CMS website. An RFA for those models hasn't been released.

Related: Medicare Just Invited More Competitors Into Value-Based Primary Care

Related: CMS Primary Cares: 5 Steps to Assess Your Readiness

Related: Medicare's Primary Care First Program Has Its Skeptics

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


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