CMS Announces New MCP Model for Primary Care Coordination
The federal Centers for Medicare & Medicaid Services (CMS) on Thursday, June 8 announced the establishment of an entirely new alternative payment model (APM), with the intention of improving care management and care coordination in primary care, for patients being cared for across both Medicare and Medicaid.
In a press release posted to its website, the agency announced that, “Today, the Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested under the Center for Medicare and Medicaid Innovation in eight states. Access to high-quality primary care is associated with better health outcomes and equity for people and communities. MCP is an important step in strengthening the primary care infrastructure in the country, especially for safety net and smaller or independent primary care organizations. The model seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and leveraging community-based connections to address patients’ health needs as well as their health-related social needs.”
The agency stated that “The goals of MCP are to 1) ensure patients receive primary care that is integrated, coordinated, person-centered and accountable; 2) create a pathway for primary care organizations and practices – especially small, independent, rural, and safety net organizations – to enter into value-based care arrangements; and 3) to improve the quality of care and health outcomes of patients while reducing program expenditures.”
Further, “The MCP Model will provide participants with additional revenue to build infrastructure, make primary care services more accessible, as well as better coordinate care with specialists. CMS expects this work to lead to downstream savings over time through better preventive care and reducing potentially avoidable costs, such as repeat hospitalizations. MCP will run for 10.5 years, from July 1, 2024, to December 31, 2034. The model will build upon previous primary care models, such as the Comprehensive Primary Care (CPC), CPC+, Primary Care First models, and the Maryland Primary Care Program (MDPCP).”
To that end, “CMS will test this advanced primary care model in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. CMS will work with model participants to address priorities specific to their communities, including care management for chronic conditions, behavioral health services, and health care access for rural residents. CMS is working with State Medicaid Agencies in the eight states to engage in full care transformation across public programs, with plans to engage private payers in the coming months. The model’s flexible multi-payer alignment strategy allows CMS to build on existing state innovations and for all patients served by participating primary care clinicians to benefit from improvements in care delivery, financial investments in primary care, and learning tools and supports under the model.”
“The goal of the Making Care Primary Model is to improve care for people with Medicaid and Medicare,” CMS Administrator Chiquita Brooks-LaSure said in a statement included in the announcement. “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 press release noted that “Strong relationships with primary care teams are essential for patients’ overall health. Primary care clinicians provide preventive services, help manage chronic conditions, and coordinate care with other clinicians. By investing in care integration and care management capabilities, primary care teams will be better equipped to address chronic disease and lessen the likelihood of emergency department visits and acute care stays, ultimately lowering costs of care. This model will support participants with varying levels of experience with value-based care, including Federally Qualified Health Centers (FQHCs) and physician practices with limited experience in value-based care, as CMS continues to work to reduce disparities in care and drive better patient experience and outcomes.”
“Ensuring stability, resiliency, and access to primary care will only improve the health care system,” CMS Deputy Administrator and Center for Medicare and Medicaid Innovation Director Liz Fowler said, in a statement included in the announcement. “The Making Care Primary Model represents an unprecedented investment in our nation’s primary care network and brings us closer to our goal of reaching 100% of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care arrangements, including advanced primary care, by 2030.”
The press release went on to note that “The model includes a progressive three-track approach based on participants’ experience level with value-based care and alternative payment models. Participants, which include FQHCs, Indian Health Service facilities, and Tribal clinics, among others, in all three tracks will receive enhanced payments, with participants in Track One focusing on building infrastructure to support care transformation. In Tracks Two and Three, the model will include certain advance payments and will offer more opportunities for bonus payments based on participant performance. This approach will support clinicians across the readiness continuum in their transition to value-based care, furthering CMS’s goal to ensure 100% of traditional Medicare beneficiaries are in a care relationship with accountability for quality and total cost of care. Primary care organizations within participating states may apply when the application opens in late summer 2023. The model will launch on July 1, 2024.”
Reactions
The announcement elicited diverse reactions from associations representing physicians and other providers involved in value-based contracting. On the one hand, APG, America’s Physician Groups, the Washington, D.C.- and Los Angeles-based association representing physician groups engaged in value-based contracting, released a statement Thursday praising the announcement. Susan Dentzer, APG’s president and CEO, said that “America’s Physician Groups salutes the Centers for Medicare & Medicaid Services on its announcement today of the Making Care Primary Model, which will launch in 2024. Holding primary care physicians accountable for costs and quality is central to achieving the promise of value-based health care. It’s therefore important to continue to provide accessible “on ramps” for small practices to enable them to make what could otherwise be a difficult transition for them.
“We at APG are especially excited that Track 1 of the model is explicitly designed for federally qualified health centers, which serve some of the nation’s most vulnerable patients. The model seeks to align payment across Medicare, Medicaid, and commercial payment where possible. These approaches are also vital to stimulating the spread of value-based care.”
Furthermore, “Long-term models such as this one, which will last up to 10 years, will offer stability to participants and may therefore ensure greater participation,” Dentzer added. APG’s members are value sophisticates, and we look forward to one day welcoming veterans of the Making Care Primary model into our membership ranks once they have mastered the basics of value and can flourish in that environment.”
But NAACOS, the Washington, D.C.-based National Association of ACOs, released a statement attributed to its president and CEO, Clif Gaus, Sc.D., criticizing the move. “NAACOS is committed to increasing investment in primary care and has called for CMS to establish an option for ACOs to implement population-based payments for primary care,” Gaus stated. “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. The Making Care Primary Model is counter to these goals by excluding practices who work in an ACO. 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.”
Further, Gaus said, “To continue the shift to total cost of care models like ACOs, CMS needs to allow concurrent participation or make comparable options within the Medicare Shared Savings Program to coincide with the start of Making Care Primary. In the absence of a population-based payment option for ACOs, practices may choose to move to Making Care Primary rather than remaining in total cost of care models.”
