Making Care Primary Model: CMS Approach To Value-Based Accessibility

The Centers for Medicare & Medicaid Services (CMS) recently announced a new advanced primary care program that incorporates learnings from previous advanced primary care initiatives like the Comprehensive Primary Care (CPC), CPC+, and Primary Care First models.

Named the Making Care Primary (MCP) Model, this new initiative began July 1 of this year and will be tested in 8 states over 10.5 years. The first cohort of states includes Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington, with plans to expand elsewhere.

Making Care Primary goals

The MCP model goals include:

• Strengthening primary care
• Making value-based care contracts more attractive and feasible for primary care organizations and practices
• Improving care quality and patient health outcomes while decreasing care costs

Overall, MCP focuses on ensuring that primary care delivery is more equitable, integrated, coordinated, person-centered, and accountable via team-based care while addressing health-related social needs (HRSNs) through community connections.

What stands out to us about the Making Care Primary Model

MCP builds on previous primary care models like Comprehensive Primary Care (CPC), CPC+, Primary Care First (PCF), and the Maryland Primary Care Program (MDPCP). While the latest PCF cohorts from 2021 and 2022 still have 3 and 4 years, respectively, the MCP model offers features that could make value-based care much more attractive, particularly for small, independent, rural, and safety net organizations.

MCP offers a 10.5-year program timeframe

Selecting a 10.5-year timeframe is more than double or triple that of other advanced primary care programs. This will allow participating groups to start operationalizing the program's requirements and get their feet under them to see and advance the improvements they uncover throughout the program.

The MCP program will run from July 1, 2024, to December 31, 2034, making it one of the most prolonged Center for Medicare and Medicaid Innovation (CMMI) initiatives.

Pros: The upside is that a more extended timeframe enables participants to promote change, whether in a small practice or working with a large organization. Typically, we find that, by the time you can realize and then adopt meaningful and evidence-backed changes, the funding is close to complete.

Cons: The challenge with a prolonged program is managing attrition and having support and clear direction on handling the natural changes to the patient or physician panel, as well as any mergers or acquisitions that occur along the way.

We look forward to seeing the specifics around how CMS will provide guidance so that operational teams have a clear structure if and when changes affect their organization.

MCP provides additional revenue to build infrastructure

What's key to this primary care program? Any qualified participant with little or no value-based care experience can participate and receive investment for care integration and care management capabilities for chronic disease management, behavioral health services, and to enhance healthcare access for rural residents. Through this investment, primary care teams can equip themselves to address chronic disease and collaborate with community partners.

MCP engages in a flexible multi-payer alignment strategy

In a similar vein, Primary Care First's public-private payer strategy, Making Care Primary focuses on reducing barriers for providers to join value-based arrangements. CMS plans to align the new MCP program with various health plans, including members covered by Medicaid, commercial plans, and other payors.

After working with state Medicaid agencies in the first eight test states, CMS also plans to engage private payors. This will be crucial as having a mix of healthcare payors influences provider behavior and VBC adoption.

In a recent CMS webinar to announce MCP, state Medicaid leaders from Massachusetts shared how these types of innovation programs helped them transition 85% of Medicaid-covered lives into accountable care since 2018. As of 2023, they have more than 1.3 million beneficiaries in an accountable care organization (ACO) and more than 1,000 primary care practices currently receiving proactive primary care payments.

Working to reduce physician and administrative burden

Complexity and administrative burden are part of the reason that 75% of primary care practices are not engaged in value-based arrangements. However, the goal of the MCP program, according to CMS, is to provide “a pathway for primary care clinicians with varying levels of experience in value-based care to gradually adopt prospective, population-based payments while building infrastructure to improve behavioral health and specialty integration and drive equitable access to care."

State Medicaid agencies are currently designing Medicaid programs to align with MCP in critical areas to support physician leaders financially, operationally, and technically. By offering three tracks, the MCP model meets practices where they are and provides support so that tools and processes are easier to adopt for care management, specialist engagement, and community partnerships.

Health equity strategy is an MCP model priority

Like ACO REACH, which was the first model to incorporate health equity requirements, MCP will feature aspects that support CMMI's philosophy. As the organization overseeing the MCP program, they want to realize a vision where “equitable care is crucial to achieving high-quality care for Medicare and Medicaid beneficiaries."

Several aspects of the MCP Model will be designed to improve health equity, including:

• Offering risk-adjusted payments
• Developing a strategic plan for identifying disparities and reducing them
• Implementing HRSN screening and referrals
• Reducing cost-sharing for patients in need
• Measuring the percentage of patients screened for HRSNs

The MCP three-track approach to primary care transformation

Participants in all three tracks will receive enhanced payments.

Those in Track One will focus on building infrastructure to support care transformation, like chronic care management. Tracks Two and Three will include certain advance payments and more opportunities for performance-based bonus payments.

By supporting practices across the value-based care readiness continuum, MCP will work to reduce organizations' reliance on fee-for-service (FFS) payments.

Risk-adjusted enhanced services payments—also paid prospectively—will enable practices to implement or expand care management, screen for health-related social needs, and integrate with specialty care.

Anticipating the future

Most importantly, the MCP program gives leaders a sneak peek into where CMS is heading with VBC, advanced primary care, and health equity. Whether an organization applies and participates in Making Care Primary, this new program indicates how future reimbursement and requirements may lean in the future.

Tips to prepare: Awaiting MCP model specifications and requirements

We look forward to CMS's announcement of the Request for Applications later in summer 2023. In the meantime, here are a few thoughts on what you can do to prepare:

• Stay updated via CMS and tracking their Making Care Primary Model page for new information.
• Once published, read the model design and program specifications. Determine which track might best fit your current primary care practice or program.
• Acclimate to the programmatic requirements by doing an initial review to gauge how strong or weak your primary care operations may be now as a starting point.
• Look at how they embed health equity strategies and what that might mean for your organization.
• If your organization is interested in pursuing an MCP application, consider submitting a non-binding Letter of Intent to CMS.

Look for more details as the Request for Applications becomes available and as we follow the development of Making Care Primary.

RTI Health Advance prepares primary care for a rapidly approaching future

The sooner primary care organizations and teams embed these practices into existing workflows and services, the better prepared they will be for advancing primary care. RTI Health Advance's team of quality, clinical, operational, and data science experts can support primary care from initial application to program implementation, quality assessment and improvement, as well as data analysis and reporting. Let's prepare together. Contact us to learn more.