June 21, 2023 – In a recent exciting development, the Centers for Medicare and Medicaid Services (CMS) has given the green light to a pilot program focusing on value-based primary care. This innovative program called Making Care Primary Model is set to shake things up in eight states.

So, what’s the deal with this pilot program? The new initiative is designed to flip the script on the current primary care approach by shifting away from a fee-for-service model to a value-based payment model. In simple terms, it’s about prioritizing the quality of care over the number of services provided.

The model will launch in July 2024 and be piloted in eight states. These include Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington. These states will be the testing grounds for this paradigm shift in primary care. 

Now, let’s dig a bit deeper into this. The pilot program is poised to implement a payment model that rewards healthcare providers for improved patient health outcomes rather than the volume of care they provide. This approach is expected to lead to better health for patients and reduced costs for both patients and the healthcare system.

Participants include federally qualified health centers, Indian Health Service facilities and tribal clinics. These participants will receive enhanced payments instead of FFS to better coordinate care. The goal of the model is to improve care for patients by focusing on care managed and care coordination. Primary care physicians will also be equipped with tools to form partnerships so they can utilize community-based connections and organizations to provide whole-person care that addresses health needs and health-related social needs. 

“The goal of the Making Care Primary Model is to improve care for people with Medicaid and Medicare,” said CMS Administrator Chiquita Brooks-LaSure. “This model is one more pathway CMS is taking to improve access to care and quality of care, especially to those in rural areas and other underserved populations. This model focuses on improving care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and partnering with community-based organizations, which will help the people we serve with better managing their health conditions and reaching their health goals.”

This new pilot program is a bold move by CMS and signifies a significant step towards transforming the American healthcare landscape. There is a test period of 10.5 years, which will be significant enough to truly see the results of the program.