One Step Closer to Value-based Care: CMMI Announces New Primary Care Payment Models

Last week, the Centers for Medicare & Medicaid Services (CMS) announced what Health and Human Services Secretary Alex Azar called “an historic turning point in American health care:” the Primary Cares Initiative. This series of primary care-focused payment models—designed to transform primary care payments more directly to reward value—will test five new payment model options under two paths Primary Care First and Direct Contracting. The five payment model options under Primary Cares are designed to target different participant types and link payments to performance in varying degrees.

The Primary Cares Initiative will address shortcomings of the current fee-for-service payment system unfavorable for primary care, such as low rates, non-reimbursable services, and cash flow challenges. All five payment model options incorporate the following core aims:

  • Allow practices to move away from FFS and eliminate revenue cycle operations
  • Reduce administrative burdens by simplifying quality reporting requirements
  • Leverage performance transparency to motivate improvement and encourage competition
  • Engage multiple payers to align with model principles and strengthen the business case for participation
  • Help practices remain independent

Interested in learning more? The Accountable Care Learning Collaborative recently released the first in a two-part series that summarizes Primary Care First, outlining the model parameters known to date, available at https://www.accountablecarelc.org/publications/primary-care-first. The second part of the series will cover the DC model options and early implications for ACOs.

About the ACLC

The Accountable Care Learning Collaborative (ACLC) is a non-profit organization with a mission to accelerate the readiness of healthcare organizations to assume value-based payment models. Founded by former Secretary of Health and Human Services Mike Leavitt, and former Administrator of the Centers for Medicare and Medicaid Services Mark McClellan, the ACLC serves as the foundation for healthcare stakeholders across the industry to collaborate on improving the care delivery system.

To learn more about the ACLC, visit accountablecareLC.org.