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CMS Primary Cares Initiative – What You Need to Know

CMMI announced the CMS Primary Cares Initiative on April 22, which is comprised of several voluntary payment options focused on serving patients with complex, chronic conditions and those with serious illness. C-TAC is proud to have worked closely with CMMI on this effort and will be sharing updates on the initiative in the days and weeks ahead. While we are pleased with the initial announcement, we anticipate further details to be shared in the coming months. Here is an overview of what to expect under each program:

Primary Care First: This set of voluntary payment model options is designed to reward providers for delivering high-quality advanced primary care. One option encourages advanced primary care practices to take responsibility for seriously ill patients without a primary care practitioner or access to effective care coordination. Providers receive monthly, population-based payments from CMS, as well as a flat fee for each primary care visit. They will be held accountable through a performance-based adjustment that offers an upside of up to 50% of revenue as well as a downside of 10% of revenue incentive to improve quality and reduce costs.

Scheduled to launch in January 2020, Primary Care First Model Options will be offered in 26 regions which are indicated in a map created by the C-TAC Policy & Advocacy Manager Davis Baird, available here. CMS anticipates release of the first round of applications this Spring. There will be a second round of opportunities to apply for models starting in January of 2020, as well as opportunities for current CPC+ practices to participate in 2021. For more information about Primary Care First, please click here.

Direct Contracting: This second program creates three payment model options which allow providers caring for Medicare beneficiaries to earn rewards by taking on risk. This can include those beneficiaries with complex, chronic, or serious illnesses.

The first payment model option, known as the Professional Option, allows providers to share in 50% of savings and losses. Participants will receive a capitated, risk-adjusted payment each month for enhanced primary care services, known as Primary Care Capitation.

The Global Option offers providers an opportunity to take full risk for 100% of savings and losses and includes two payment options: Primary Care Capitation, or Total Care Capitation, risk-adjusted monthly payments for all services provided by DC participants and preferred providers with whom the DC Entity has an agreement.

CMMI is also seeking public input on a Geographic Option, a third arrangement under which providers will take responsibility for the total cost of care for all Medicare fee-for-service beneficiaries in a defined targeted region. A Request for Information has been issued for this model option, for which CMMI will be accepting input through 11:59 PM EDT on May 23.

The Professional and Global Options are scheduled to start in January 2020, with the Geographic Option expected to follow in mid-2020. For more information about Direct Contracting, please click here. CMS will be hosting webinars to provide more information about Primary Care First on April 30 at 12 PM and 3 PM ET, as well as on May 16 at 12 PM and 3 PM ET. We also invite you to join our upcoming webinar at 1 PM ET on May 23 as C-TAC Senior Regulatory Advisor Marian Grant and Senior Policy Advisor Andrew MacPherson share insight on the latest developments in the Primary Cares initiative.

For more information about C-TAC’s policy and advocacy efforts, please contact Policy & Advocacy Manager Davis Baird at dbaird@thectac.org.

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