Primary Care First is a set of voluntary alternative five-year payment options that reward value and quality by offering an innovative payment structure to support the delivery of advanced primary care. In response to input from primary care clinician stakeholders, Primary Care First is based on the principles underlying the existing Comprehensive Primary Care Plus (CPC+) model design: prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs, and focusing financial incentives on improved health outcomes.
Primary Care First is offered in 26 regions: Alaska (statewide), Arkansas (statewide), California (statewide), Colorado (statewide), Delaware (statewide), Florida (statewide), Greater Buffalo region (New York), Greater Kansas City region (Kansas and Missouri), Greater Philadelphia region (Pennsylvania), Hawaii (statewide), Louisiana (statewide), Maine (statewide), Massachusetts (statewide), Michigan (statewide), Montana (statewide), Nebraska (statewide), New Hampshire (statewide), New Jersey (statewide), North Dakota (statewide), North Hudson-Capital region (New York), Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky), Oklahoma (statewide), Oregon (statewide), Rhode Island (statewide), Tennessee (statewide), and Virginia (statewide).
Primary Care First includes two cohorts of participating practices: Cohort 1 began in January 2021 and Cohort 2 will start in January 2022.
There are currently 847 practices participating in Cohort 1 of Primary Care First (List) and 14 payer partners as of 2/25/2021.
Primary Care First aims to foster practitioner independence by increasing flexibility for primary care, providing participating practitioners with the freedom to innovate their care delivery approach based on their unique patient population and resources. PCF participants may receive additional revenue based on their performance on easily understood, actionable outcomes.
In Primary Care First, CMS uses a focused set of clinical quality and patient experience measures to assess quality of care delivered at the practice. A PCF practice must meet standards that reflect quality care in order to be eligible for a positive performance-based adjustment to their primary care model payments. These measures were selected to be actionable, clinically meaningful, and aligned with CMS’s broader quality measurement strategy. Measures include a patient experience of care survey, controlling high blood pressure, diabetes hemoglobin A1c poor control, colorectal cancer screening, and advance care planning. CMS assesses quality of care based on a separate, focused set of measures that are clinically meaningful for patients with complex, chronic needs, and the serious illness population.
To amplify the impact of the model, Primary Care First is designed as a multi-payer model. Primary Care First payer partners commit to aligning with the model’s payment methodology, quality measurement strategy, and data sharing approach in order to align resources and incentives across a participating practice’s entire patient population. Payer partners include Medicare Advantage plans, commercial health insurers, State Medicaid agencies, and Medicaid managed care plans (to the extent permitted and consistent with the Medicaid managed care plan’s contract with the state).
Primary Care First aims to improve quality, improve patient experience of care, and reduce expenditures. CMS believes that the model will achieve these aims by increasing patient access to advanced primary care services. PCF has elements specifically designed to support practices caring for patients with complex chronic needs or serious illness. The specific approaches to care delivery are determined by practice priorities. Practices are incentivized to deliver patient-centered care that reduces acute hospital utilization or total per capita cost. PCF is oriented around five comprehensive primary care functions:
- Access and continuity;
- Care management;
- Comprehensiveness and coordination;
- Patient and caregiver engagement; and
- Planned care and population health.
Primary Care First aims to be transparent, simple, and hold practitioners accountable by:
- Providing model payments to practices through a simple payment structure, including:
- A flat payment that encourages patient-centered care, and compensates practices for in-person treatment;
- A population-based payment to provide more flexibility in the provision of patient care along with a flat primary care visit fee; and
- A performance-based adjustment providing an upside of up to 50% of model payments as well as a small downside (negative 10% of model payments) incentive to reduce costs and improve quality, assessed and paid to practices on a quarterly basis.
- Providing practice participants with performance transparency, through identifiable information on their own and other practice participants’ performance to enable and motivate continuous improvement.
Primary Care First provides the tools and incentives for practices to provide comprehensive and continuous care, with a goal of reducing patients’ complications and overutilization of higher cost settings, leading to higher quality of care and reduced spending.
For more information visit; https://www.cms.gov/newsroom/fact-sheets/primary-care-first-model-cohort-2-cy-2021-fact-sheet