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New Payment Model Announced for Primary Care Providers

CMS launches Primary Care First to improve quality of care

CMS recently announced a new payment model structured to improve and reward value and quality of care for Primary Care Providers (PCPs). The new program, called Primary Care First, is set to launch in January 2020.

According to CMS, the motivation behind the initiative is the fact that the utilization of PCPs for the management of severe and chronic illness is only a small part of the total cost of care. HHS Secretary Alex Azar commented, “For years, policymakers have talked about building an American healthcare system that focuses on primary care, pays for value, and placed the patient at the center. These new models represent the biggest step ever taken toward that vision.”

The new program builds upon the existing CPC+ model for PCPs but takes CPC+ a step further by giving providers the flexibility to create a seamless continuum of care for chronically and seriously ill patients.

Under the plan, PCPs will be paid to deliver care both in and outside of the office to reduce hospitalization and decrease total costs. Additionally, CMS is exploring options within this plan to increase primary care utilization by offering incentives for patients such as payment waivers.

New programs that reward quality of care and value are not the only reimbursement changes healthcare organizations are facing. High deductible plans, which make patients responsible for a more significant percentage of overall revenue, are a challenge as well.

To learn more about the Primary Care First program, visit the CMS website