Since the CMS announcement back in April 2019, we have been eagerly awaiting the details of Primary Care First, a new advanced primary care initiative. CMS released a detailed request for application last month, answering many questions, laying out a timeline for participation, and inviting applications. This new opportunity is open to primary care practices that have experience with value-based payment and are ready for a higher ready of risk. Caravan Health recently held a webinar to go over the details of this new model and explain how it fits in the world of value-based payment. Check out the recording here.

Louise Yinug and LeeAnn Hastings from Caravan Health kicked off the discussion by reviewing how the program works. Primary Care First Model is based on the principles of an existing program, Comprehensive Primary Care Plus (CPC+), using payment incentives to encourage advances in primary care, such as next level care coordination. PCF will be available in 26 regions, including the 18 CPC+ regions. PCF practices will participate for five years either serving a general Medicare population, a high-needs, seriously ill population, or both.

How does payment work?

A PCF practice will get three streams of revenue from the program.

  1. Each practice receives an up-front risk adjusted population-based payment. The amount of this payment depends on the health profile of the practice’s patient population, as measured by HCC score. There are four risk tiers, down from five in the April announcement. CMS combined the two lowest tiers in response to feedback.
  2. CMS will pay a flat fee for each primary care visit. This fee includes Evaluation and Management (E/M) office and outpatient visits, annual wellness visits, and certain care management.
  3. Practices can receive a quarterly performance adjustment for achieving quality goals. For their first year, the performance payment is based on hospital utilization only. Starting in year 2, practices must pass a Quality Gateway to continue to get that performance-based bonus. The Quality Gateway is based on a set of clinical quality and patient experience measures designed to ease burden on practices by making use of information they are already submitting for MIPS or other quality assessment. The number of measures is determined in part by the risk tier of the patient populations.

How does this program interact with other value-based payment initiatives?

Primary care practices can participate in PCF along with other VBP models, including ACOs. The main limitations are that CPC+ practices can’t apply to participate until 2022, and RHCs and FQHCs are also not eligible.

How to apply

CPC+ is taking applications from now until January 22, 2020 for a 2021 start. This first round is only for practices that are not currently participating in CPC+. CPC+ practices will have an opportunity to apply for a 2022 start sometime next year. For payers interested in being part of the model, CMS is asking for letters of interest before December 6.

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