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The application deadline for interested physician practices to participate in the Centers for Medicare & Medicaid Services’ (CMS) new primary care payment model is Nov. 30, and the AMA has partnered with other organizations to produce a webinar designed to answer any questions physicians may have about it.
The webinar, produced by the AMA with the American Academy of Family Physicians and the American College of Physicians, is available on demand, and it features CMS experts explaining the new Making Care Primary model and answering physician questions live.
The multipayer model will run from July 2024 to December 2034 in eight states and is designed to create a new pathway for primary care practices—with small, independent, rural and safety-net organizations especially in mind—to enter into value-based care arrangements while improving quality of care and patient outcomes.
Earlier this year, the AMA voiced support for the model.
“We’re encouraged to see many of the AMA’s recommendations featured in this model, including a longer model test, a voluntary, progressive model that meets practices where they are and provides on-ramps for them to advance into prospective payment, and meaningful alignment with Medicaid,” said AMA Immediate Past President Jack Resneck Jr., MD.
“The longer test period of 10.5 years directly responds to AMA efforts calling for more transparency and stability to foster trust and encourage physician participation,” Dr. Resneck added. “The AMA strongly believes value-based care models are essential to the long-term well-being of the Medicare program and its ability to meet the needs of a diverse and aging population.”
Physicians in these eight states are eligible to participate: Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington. In New York, only practices upstate—that is, north of Westchester County—are eligible.
CMS has secured agreements from these states’ Medicaid programs to participate.
Additionally, to be eligible, applicants must have:
- A majority of their facilities located in an eligible state.
- A minimum of 125 attributed Medicare beneficiaries.
- At least 40% of their Medicare service revenue from primary care services.
The model is intended to give primary care organizations more financial, data and learning support to help them move away from fee-for-service and into a population-based, value-based care payment system, Nicholas Minter, director of the CMS Innovation Center’s division of advanced primary care, said in the webinar.
“Our goal is to make sure that we are reaching all primary care practices and to empower them to focus on population health and to provide pathways for primary care organizations that have been left behind by the value-based care movement or are simply trying to figure out if their current pathway is one that is sustainable for them,” Minter said. “From our standpoint, primary care is a specialty that has seen its complexity go up and its resources haven’t followed suit.”
The model includes three tracks designed to “meet practices where they are” in terms of readiness, according to CMS.
Practices can generally elect which track they’d like to participate in, with an exception that the first track is generally reserved for practices that are getting started with value-based care. It includes an upfront payment for building infrastructure to develop advanced primary care services through such activities as risk stratifying their patient population and designing workflows for chronic disease management, behavioral health and screening for health-related social needs and referral.
Practices can remain in the first track for 2.5 years before moving to track two, which includes implementing advanced primary care services such as chronic disease management for patients at high risk of health deterioration.
A collaborative-care agreement with at least one of these specialties: cardiology, orthopaedics or pulmonology is required starting a year into track two.
Activities in the third track include specialty care integration and other advanced primary care services for which Minter said practices will be “rewarded significantly more than they were in fee for service for improving patient outcomes over time.”
“For practices that are a little behind, this is designed to help them catch up,” he said.