Healthcare Orgs Push for Hybrid Primary Care Payment Option in MSSP

More than 25 healthcare organizations have urged CMS officials to establish a hybrid primary care payment option in the Medicare Shared Savings Program (MSSP) to enhance primary care and boost accountable care organization (ACO) participation.

The organizations, including the National Association of ACOs (NAACOS) and AMGA, highlighted the importance of strong primary care and how it can lead to better health outcomes, lower costs, and greater equity within ACOs.

The request aligns with recommendations in the 2021 NASEM Report, Implementing High-Quality Primary Care, and furthers CMS’ strategic goals, according to the organizations.

The letter detailed six principles that should govern the hybrid payment option in the MSSP.

First, the option should reflect beneficiaries’ social risk and encourage efforts to address health-related social needs and social determinants of health. The payment option should also account for participants’ capabilities and capacity to take on risk and include incentives for practices that serve more vulnerable and at-risk populations, such as small, safety-net, and rural primary care practices.

Second, the payment option must include value for beneficiaries, including cost-sharing relief from services covered by the per-beneficiary payment. Additionally, the option should allow for enhanced primary care payments to support coordinated care and address beneficiaries’ behavioral health.

The organizations also said that the payment option should result in increased investment in primary care, with practices receiving a share of financial incentives for improved performance.

“Primary care practices should be empowered with data and transparent information to shape the decisions that impact their practice and the ACO,” the letter stated. “Meaningful participation of primary care in the governance of the ACO is key.”

ACOs should not be required to implement the hybrid payment option and MSSP participation must remain voluntary, the groups said. The option should also be implemented in 2025 and have no limited window for new participants and no geographic restrictions on participation.

Finally, the option must create additional value for Medicare through expanded primary care, enhanced ACO participation in MSSP, and better overall program performance.

The letter recognized that introducing a new option within MSSP is complex and requires significant effort. However, the organizations are committed to working with CMS and providing necessary input to help design the option within a reasonable time.

“We stand ready to bring the primary care and ACO communities together in support of efforts to expand options within MSSP that we believe will strengthen primary care and result in enhanced value for the program and its beneficiaries,” the groups wrote. “Neither Medicare beneficiaries, the nation’s primary care practices, nor MSSP ACOs can wait for progress and watch the primary care platform be weakened further. We urge CMS action this year.”