CMS Starts Primary Care First Value-Based Payment Model Second Wave

The Centers for Medicare and Medicaid Services (CMS) has opened applications for the second cohort of the Primary Care First (PCF) value-based payment model which seeks to drive down costs and increase quality of care.

As the healthcare industry moves toward value-based care delivery, the PCF model will explore if switching from fee-for-service to Medicare performance-based payments could increase quality of care and reduce overall Medicare costs.

Through the model’s performance-based payment adjustments, participating practices in eligible regions will be rewarded for positive patient outcomes. Additionally, these practices will have more flexibility in tailoring their care delivery approaches to address the needs of unique patient populations than practices in traditional fee-for-service models.

Designed with input from primary care clinician stakeholders, Primary Care First is based on the principles of the existing Comprehensive Primary Care Plus (CPC+) model design which focuses on incentivizing positive patient outcomes, prioritizing the doctor-patient relationship, and enhancing care for patients with complex chronic needs.

By basing Medicare payments on quality of care and not quantity of services, the model seeks to improve advanced primary care for both practices and patients. Performance-based payments will allow practices to prioritize patient-provider relationships, patient experience, and care coordination to drive better patient outcomes.

The PCF model comes as part of the HHS Primary Care Initiative unveiled on April 22, 2019 which aims to lessen both administrative burdens and healthcare costs while improving quality of care. The initiative includes five value-based payment models through two tracks: PCF and Direct Contracting.

Together, both tracks signal a “pivotal, hockey stick moment in paying for value in American healthcare,” Alex Azar, HHS secretary at the time, said in a press conference at the time of the program’s announcement.

“This initiative will radically elevate the importance of primary care in American medicine, move toward a system where providers are paid for outcomes rather than procedures, and free doctors to focus on the patients in front of them, rather than the paperwork we send them,” Azar continued.

Direct Contracting includes higher levels of financial risk than PCF and is designed for large organizations with tenure in value-based payments.

PCF is geared towards smaller primary care practices and includes two payment models; one is for standard primary care practices, while the other is for providers who care for seriously ill patients, known as the high-need populations payment model option.

This second payment option encourages advanced primary care practices, including practices that deliver hospice and palliative care services, to become accountable for high-need patients who currently do not have a primary care practitioner or effective care coordination.

Under the high-need populations payment model, practices receive larger population-based payments to mirror the high-risk nature of caring for the seriously ill population.

CMS wants to ensure that practices that take part in the high-need populations payment model option have access to the services seriously ill patients require for their long-term health and wellness needs. Therefore, in order to receive the higher payments, practices must demonstrate that they have a strong network of relationships with other care organizations in the community.

PCF Cohort 1 began in January 2020 and PCF Cohort 2 is set to begin in January 2022. The model will have five performance years. To access the practice application and learn more about the PCF Model, visit the CMS Primary Care First website.

At this time, 847 primary care practices and 14 regional health plan partners have opted into the alternative care model.

The deadline for practice applications is April 30, 2021, and the deadline for payer applications is May 28, 2021. Three webinars with live question and answer sessions will be held over the next few weeks for interested applicants.