CMS to pilot value-based primary care model in 8 states

CMS is piloting a value-based primary care model in eight states through the Center for Medicare and Medicaid Innovation that will seek to create more coordinated care for rural and underserved populations.

The Making Care Primary Model will be tested from July 2024 to the end of 2034 in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington state, according to a June 8 news release from CMS.  

The agency said the new model will offer additional payments to participating primary care organizations and practices, especially those with limited experience in value-based care such as small, independent, rural and safety net organizations. The new arrangements will help make primary care more accessible and more coordinated with specialists. 

CMS said it will work with participants, which will include federally qualified health centers, Indian Health Service facilities and Tribal clinics, to address needs specific to their communities, including care management for chronic conditions, behavioral health services, and healthcare access for rural residents. The agency is also working with state Medicaid programs in the eight states and plans to involve commercial payers "in the coming months."

"The model's flexible multipayer alignment strategy allows CMS to build on existing state innovations and for all patients served by participating primary care clinicians to benefit from improvements in care delivery, financial investments in primary care, and learning tools and supports under the model," CMS said.

The model includes a three-track approach based on participants' experience level with alternative payment models, though participants in all three tracks will receive enhanced payments. Track one participants will focus on building the infrastructure needed to support care transformation, while tracks two and three will include advance payments and more opportunities for bonus payments based on participant performance. 

CMS noted that the new model supports its goal of placing all traditional Medicare beneficiaries and most Medicaid enrollees in an ACO by 2030. The model will also build on previous primary care models, including the Comprehensive Primary Care, CPC+, Primary Care First, and Maryland Primary Care Program.

Applications for the program will open in late summer 2023, with a launch date of July 1, 2024.

More information is available here.

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