CMS debuts Making Care Primary Model to promote value-based care

The Centers for Medicare and Medicaid Services will test a primary care model that aims to improve access and quality by promoting value-based care, with an emphasis on providers that 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 health centers, Indian Health Service providers, small physician practices and rural providers, in transitioning to value-based care. When the initiative takes effect in July 2024, participating providers will qualify for enhanced reimbursements to help shift from the fee-for-service system and to better coordinate and manage care.

“The goal of the Making Care Primary Model is to improve care for people with Medicaid and Medicare,” CMS Administrator Chiquita Brooks-LaSure said in a news release. “This model focuses on improving care management and care coordination, equipping primary care clinicians with tools to form partnerships with healthcare 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.”

The primary care initiative is a component of CMS’ 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 Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care arrangements, including advanced primary care, by 2030,” Center 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. Applications will be available in late summer 2023, the agency said.

The enhanced reimbursements will be risk-adjusted to suit patient populations and community needs, CMS said. Although providers will continue to be paid under existing fee-for-service reimbursement systems, the Making Care Primary Model is designed to shift them away from relying on traditional payment models and prepare them for novel payment arrangements.

The model aims to bolster and transform healthcare delivery in primary care in three parts: care management, through which participants offer support services; care integration to align primary care providers with mental health practitioners and other specialists; and community integration to address health-related social needs.

Providers will be grouped into three tracks, largely based on their prior experiences with value-based care, and will advance through these stages over time. Track 1 is intended for those who require support to incorporate value-based care into their practices. In Track 2, providers will partner with social services organizations and medical specialists, screen patients for behavioral health conditions and institute care management programs. Track 3 incorporates all elements from the first two phases and introduces population-based prospective payments.