New “Making Care Primary Model” Takes Value-Based Payments to Primary Care
CMS piloting new VBP model for primary care in eight states starting July 2024
THE VBP Blog
July 12, 2023 – Every so often, an innovative approach emerges in the healthcare landscape and becomes poised to reshape our understanding and delivery of care. One such strategy is the Making Care Primary (MCP) Model, a value-based initiative that holds the promise of enhanced quality, accessibility, and efficiency in primary care.
This model is being launched in a pilot phase by CMS to assess the effect of care management, care integration, and community connection. Value-based payments have crept into almost all sectors of healthcare, and it only seems logical that it would have a positive effect on primary care as well. This could be good news for consumers, as preventative primary care can have a big impact on improving health outcomes. In this blog, we will delve into the intricate framework of this model, the multiple benefits it offers, and the transformative potential it holds for the future of primary healthcare.
The Making Care Primary Model – A Value-Based Initiative with Lofty Goals
Launched by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, the MCP Model signifies an ambitious 10.5-year commitment aimed at transforming primary care delivery for people with Medicaid and Medicare across eight states. This model builds off previous primary care models, including the Comprehensive Primary Care (CPC), CPC+, and Primary Care First (PCF) models, as well as the Maryland Primary Care Program (MDPCP). It’s important for consumers that we get these models right before they expand nationwide, similar to the Expanded Home Health VBP (HHVBP) Model, so it is encouraging to see the Innovation Center building off previous models, taking the good parts of them and reworking parts that may not have had the desired effect.
Starting next summer in July 2024, the Making Care Primary value-based payment model will be tested in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. These states were selected after a careful review of geographic diversity, health equity opportunity, population, current CMMI initiatives, generalizability to the rest of the Medicare population for model evaluation, and the ability to align with state Medicaid agencies. CMMI wants to test a diverse array of the Medicare and Medicaid population, but also be able to generalize it so nationwide figures and assumptions can be made when determining the feasibility and impact of expansion.
The core intent of the program is simple – to redirect the focus from a fee-for-service system towards preventive and comprehensive care. The overall goal, as is true with most value-based payment models, is to improve overall health outcomes while reducing costs. To do this, the model aims to expand and enhance care management and care coordination, equip primary care providers with the tools they need to form partnerships with specialists, and allow them to leverage community connections to meet both health and health-related social needs. The focus of the MCP value-based payment model is to strengthen the overall network of providers, specialists, behavioral health providers, social services providers, and others to provide preventative whole-person care.
Purpose and Design of the MCP Model
When you think about it, primary care physicians are the first line of defense. These individuals see patients at least annually and are tasked with preventative care, screening, management of chronic conditions, and helping patients maintain overall wellness. Making Care Primary is designed to increase the investment in primary care so that consumers can access efficient, high-quality, and whole-person care from their primary care provider.
What is so unique about this model is that CMS recognizes not every primary care organization is at the same point. That is why there is a three-track approach that meets providers where they are. Track 1 is all about building infrastructure so participants in the model will begin to develop the foundation for implementing advanced primary care services. Payments in this track will remain fee-for-service (FFS) as CMS provides incremental financial support to help providers develop transformative care services and delivery infrastructure. During Track 1, participants in MCP can begin to earn additional financial rewards for improved patient health outcomes.
Participants then progress to Track 1, which builds on Track 1 requirements. During this phase, they will partner with social service providers and specialists, begin screening for behavioral health conditions, and implement care management services. Payment during Track 2 shifts down the VBP continuum to a 50/50 blend of prospective, population-based payments and FFS payments. CMS continues to provide financial support, though at a lower level than Track 1, and participants are expected to continue building out their enhanced care delivery capabilities.
Once Making Care Primary participants progress to Track 3, they implement quality improvement frameworks to optimize and improve workflows, improve care integration by addressing silos, develop social services and specialty care partnerships, and deepen connections to community resources to meet health-related social needs. Payments during Track will shift to fully prospective, population-based payment. CMS will also continue to provide additional financial support to sustain care delivery activities, and participants can earn larger financial rewards for improved patient health outcomes.
What’s unique about this three-track approach and the 10.5-year timeframe, is that it is clear that the CMS Innovation Center recognizes that this transformation will not occur overnight. It takes time to expand care delivery services and develop partnerships with specialty care partners and social services organizations. But primary care is the first line of defense and plays such a huge role on health outcomes, so it is worth the investment, and it is worth studying this model in depth to ensure that we get it right. Better care coordination and integration is what consumers deserve and CMS is trying to find the best way to bring that to the forefront.
Looking Ahead – Will Making Care Primary Mirror Other Innovation Center Models?
The launch of the MCP Model reminds us of a similar groundbreaking initiative: the Home Health Value-Based Purchasing (HHVBP) Model. The latter started as a pilot, and upon demonstrating its success, was expanded nationwide in 2023. Should the MCP Model follow a similar trajectory, it could play a pivotal role in ushering in a new era for primary care and value-based payments.
However, if this is the case, like the Expanded HHVBP model, it should only come after careful review of results and only if it will truly improve health outcomes for consumers. It is promising to see CMS bringing value-based payments to the forefront of primary care, but only time will tell if the model provides the expected results.
Advocates Perspective
The introduction of the Making Care Primary Model signifies a momentous shift towards a value-based healthcare system. With its focus on primary care, the model aspires to enhance health outcomes while promoting efficiency and cost-effectiveness in the healthcare system. As we move forward, the opportunities and challenges that lie ahead will shape the trajectory of this transformative initiative. If we can glean insights from the success of the Expanded HHVBP Model, which started as a pilot and was recently expanded nationwide, we can remain hopeful about the potential nationwide expansion of the MCP Model down the road. As we continue to navigate this exciting transition in healthcare, we will keep a close eye on the results of the MCP Model and see if it provides results that show the potential that value-based care has to reshape our health systems for the better.
Onward!
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.