New CMS Primary Cares Initiative Designed to Ignite Transformation to Value-based Primary Care

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On April 22, the U.S. Department of Health & Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) announced the new CMS Primary Cares Initiative, offering primary care practices and other healthcare providers with five new payment model options designed to ignite transformation to value-based care in primary care settings across the country.

AAFP Vice Speaker Russell Kohl, MD (Stillwell, KS) joined HHS Secretary Alex Azar, CMS Administrator Seema Verma, MPH, and CMS Center for Medicare & Medicaid Innovation (CMMI) Director Adam Boehler to unveil the payment models during a press event on April 22 in Washington, DC.

Design of the initiative’s Primary Care First and Direct Contracting test payment models were influenced heavily by physician input, including AAFP’s Advanced Primary Care Alternative Payment Model, according to an HHS press release. They give clinicians different options as they strive to advance the goal of delivering better care at lower cost while allowing them to focus on caring for patients.

Five Payment Models, Two Paths

As explained by AAFP, the Primary Care First and Primary Cares First High-need Populations models focus on individual primary care practice sites and will be tested for five years beginning in January 2020. A second round of applications is scheduled for participants starting in January 2021.

The three Direct Contracting payment models (Global, Professional, and Geographic) focus on transforming primary care by allowing physicians and other healthcare providers to take greater control of managing costs of care for an aligned population of Medicare fee-for-service beneficiaries. Different from the Primary Care First models, these three Direct Contracting models aim to engage entities such as accountable care organizations, Medicare Advantage plans, and Medicaid managed care organizations that have experience taking on financial risk and serving large patient populations. Participants in the DC models will receive fixed monthly payments.

Organizations participating in the DC Global payment model will assume full financial risk, whicle those in the DC Professional payment model will share risk with CMS. The DC Geographic population-based payment model, with an expected launch date of January 2021, will ask organizations to assume the total cost of care and health needs of a population in a defined target region. CMS is seeking public comment on this final option.

AAFP Applauds CMS Primary Cares Initiative

Following the unveiling of CMS Primary Cares Initiative, AAFP President John Cullen, MD, FAAFP said in a statement, "For more than 20 years, the AAFP and our primary care colleagues have worked to create a delivery system that encourages innovation in primary care delivery and that rewards comprehensive, continuous, patient-centered care rather than simply episodes of care. Throughout this time, the AAFP has provided family medicine’s perspective and input. That effort is ongoing, and we’ll continue to work with CMS and CMMI to build a stronger foundation of primary medical care that is patient-centered and focused on value and outcomes.

"For decades, research has demonstrated the relationship between primary care and improved outcomes, better overall health and longer life expectancy. Recent research has shown how little investment Medicare makes in primary care. Today marks an important step toward recognizing the importance of primary care by developing payment models that value primary care.

"We applaud the introduction of new primary care delivery and payment models, and we look forward to working with CMS and CMMI on testing these new models as we continue our pursuit of a healthcare system built on a strong foundation of primary care."

Learn More

To help guide family physicians moving forward, AAFP is conducting a deep-dive analysis of the details of the entire CMS Primary Cares Initiative and will provide an executive summary in the near future.

Meanwhile, CMS is hosting multiple one-hour informational webcasts (each webcast will cover the same information):

Primary Care First
Informational Session 1: Tuesday, April 30, 12-1 pm ET  Register to attend
Informational Session 2: Tuesday, April 30, 3-4 pm ET  Register to attend
Informational Session 3: Thursday, May 16, 12-1 pm ET  Register to attend
Informational Session 4: Thursday, May 16, 3-4 pm ET  Register to attend

Direct Contracting
Informational Session 1: Thursday, May 2, 3-4 pm ET  Register to attend
Informational Session 2: Tuesday, May 7, 3-4 pm ET  Register to attend