The Centers for Medicare and Medicaid Services will pilot a primary care model that improves access and quality by promoting value-based care, with a focus on providers who lack experience with alternative reimbursement arrangements, the agency announced Thursday.
The Making Care Primary model seeks to support Medicare and Medicaid providers, including federally qualified medical centers, Indian Health Service providers, small physician facilities and rural providers, in the transition to value-based care. When this initiative goes into effect in July 2024, participating service providers will be eligible for enhanced reimbursements to help transition from a fee-for-service system to coordination and management. better care.
“The goal of the Making Care Core Model is to improve care for people with Medicaid and Medicare,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “This model focuses on improving care management and care coordination, equipping primary care clinicians with the tools to form partnerships with healthcare professionals. and partnering with community-based organizations, which will help the people we serve better manage their health and achieve their health goals.”
The primary care initiative is one component of CMS’s broader focus on expanding value-based care. “The Making Care Primary model represents an unprecedented investment in our nation’s primary care network and brings us closer to our goal of reaching 100% of traditional and most mainstream Medicare beneficiaries. number of Medicaid beneficiaries in responsible care arrangements, including enhanced primary care, by 2030,” Centers for Medicare and Medicaid Innovation Director Liz Fowler said in the news release.
In collaboration with state Medicaid agencies, CMS plans to run this pilot program in Colorado, Massachusetts, Minnesota, New Jersey, New York, North Carolina, and Washington state through 2034. Signing will be available by the end of summer 2023, the agency said.
CMS says enhanced reimbursements will be risk-adjusted to match patient populations and community needs. While service providers will continue to be paid under existing fee-for-service reimbursement systems, the Making Care Core Model is designed to move them away from reliance on payment models. traditions and prepare them for new payment arrangements.
This model aims to enhance and transform primary health care delivery into three parts: care management, through which participants provide support services; care integration to arrange primary care providers with mental health doctors and other professionals; and community integration to address health-related social needs.
Providers will be grouped into three groups, largely based on their previous experience with value-based care, and will progress through these stages over time. Roadmap 1 is for people who need support to incorporate value-based care into their practice. In Track 2, providers will partner with social service organizations and health professionals, screen patients for behavioral health conditions, and establish care management programs. Roadmap 3 combines all the elements from the first two phases and introduces potential population-based payouts.