CMS Axes Primary Care First Model’s Seriously Ill Population Component

CMS has notified providers via email that it will not move forward with the Seriously Ill Population (SIP) Component of the Primary Care First Model. The Model started in 2021 but the Biden Administration delayed implementation of the SIP Component in March.

The federal agency said it decided to cancel the SIP Component because of low participation interest.

“After careful review, CMS has determined that the proposed SIP outreach method, which was designed to comply with statutory beneficiary privacy protections, is unlikely to result in sufficient beneficiary uptake to allow for model evaluation,” the email sent on Nov. 30 stated.

CMS is planning to start a second cohort of Primary Care First participants in January 2022. The practice solicitation period for Primary Care First Cohort 2 ended on May 21, while the payer solicitation period ended on June 18. Selections will be announced in Fall 2021, according to CMS’ Innovation Center.

However, the SIP Component is no longer an option for interested participants in the select areas where the Primary Care First Model is running.

The SIP Component was one of two options for practices and was designed specifically for advanced primary care practices that treat high need, seriously ill beneficiaries. Practices had the option of participating in either a general component, the SIP Component, or both.

Practices in the SIP Component would have received greater population-based payments compared to the general Primary Care First Model participation option. With the higher payments, practices in this Component were expected to coordinate care for more complex patients, including those without an established primary care provider.

CMS described the SIP Component as “a novel method for identifying and attributing eligible beneficiaries to participants.”

However, central to the SIP Component was a “beneficiary outreach process that effectively engages and recruits beneficiaries,” the agency added in the email. This beneficiary outreach process was crucial to ensuring that enough beneficiaries were attributed to SIP Component practices so CMS could assess the effectiveness of the model, including whether it improved patient outcomes and/or reduced total costs of care.

CMS said in the email that the Innovation Center is still committed to testing models that focus on improve care delivery for seriously ill populations.

“As part of the Innovation Center’s strategy refresh, we will be exploring additional ways to serve these beneficiaries, whether through existing models or new model opportunities. We look forward to providing more information when available,” the email stated.

The Innovation Center laid out a new strategy for advancing value-based care through its models earlier this year. The strategy includes five pillars—driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve system transformation—and will likely require more mandatory participation to improve evaluations of models.

The Primary Care First Model is a voluntary, five-year arrangement, with 822 practices and 14 payer partners participating as of April 6.