Making Care Primary: Top insights into the new CMS initiative

CMS recently announced its newest Center for Medicare and Medicaid Innovation (CMMI) model: Making Care Primary (MCP). 

Goal of MCP¹

1. 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.
   3. Improve the quality of care and health outcomes for patients while reducing program expenditures.

Important to note: Practices currently participating in the Primary Care First model are not allowed to participate in MCP.

Implementation Details and Requirements²

• • There will be a multi-state integration beginning in eight states: Colorado, New Mexico, Massachusetts, Minnesota, New Jersey, New York, North Carolina, and Washington.
    • • CMS selected these states because they met criteria related to:
        • • Geographic diversity.
          • Health equity opportunities.
          • Current CMMI footprint.
          • Generalizability to the Medicare population.
          • Alignment with State Medicaid agencies.

• • Practices must be Medicare enrolled and bill for health services for at least 125 Medicare enrollees on panel.
  • Practices must have more than 51% of their primary care sites located in a MCP state.

MCP Model Design

MCP is CMS’s longest model released to date – a 10.5-year performance period – and includes three progressive tracks of participation, with a phase-in to fully prospective, population-based payments in Track 3.

The three track options include:²

• • Track 1 –Building Infrastructure: Participants begin developing the foundation for advanced primary care service implementation. This includes:

• • • • 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. Participants can begin earning financial rewards for improving patient health outcomes in this track.

• • Track 2 – Implementing Advanced Primary Care: Participants build upon Track 1 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, but at a lower level than Track 1. Participants will be able to earn increased financial rewards for improving patient health outcomes. 

• • Track 3 – Optimizing Care and Partnerships: Here, participants will expand upon the requirements of Tracks 1 and 2 by using quality improvement frameworks to:

• • • • Optimize and improve workflows;
      • Address care silos;
      • 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. Participants continue to have the opportunity to earn financial rewards for improving patient health outcomes.

CMS released a formal Request for Applications in August 2023 where interested organizations could submit a non-binding Letter of Intent to CMS. 

Contact us to see how a partnership with Lifepoint can provide the necessary regulatory support to help your hospital make the best decision for your patients, staff and community.

References:

1. Centers for Medicare and Medicaid Services. (2023, June). Press release CMS announces multi-state initiative to Strengthen Primary Care. CMS. https://www.cms.gov/newsroom/press-releases/cms-announces-multi-state-initiative-strengthen-primary-care
2. ATI Advisory. (2023, July). Making Care Primary (MCP) FQHC and IHP Overview Webinar. PPT