The Centers for Medicare & Medicaid Services recently announced a new primary care payment model that will provide an alternative to Comprehensive Primary Care Plus. This new model, called Primary Care First, will be offered in 26 states and regions beginning Jan. 1, 2020. Department of Health and Human Services Secretary Alex Azar predicts that the models will enroll 25 percent of traditional Medicare beneficiaries and providers, who must apply to take part, and the program may roll out to all states after five years pending its success.
Here’s what CMS has released so far about their new initiative.
Benefits of Primary Care First
Primary Care First, or PCF, will provide primary care practices a range of opportunities to advance their care delivery, increase their revenue, and reduce their administrative burden. It’s also designed to reward positive patient outcomes, increase transparency, and improve care for populations with increased need.
PCF incentivizes comprehensive care and promotes innovative techniques for providing it. Providers enrolled in the five-year, alternative payment model will be rewarded for preventing unnecessary hospital admissions, ensuring access for those with complex or chronic health conditions, and generally achieving better outcomes for their patients, all of which reduce Medicare spending in the long run.
The program will also reduce the amount of paperwork required for practices to prove their outcomes. Less paperwork means providers have more time to spend with their patients, something Acclivity Health’s platform also prioritizes.
“The ACOs struggled, not because past payment models weren’t well designed, but because they were so process-laden,” says Jeremy Powell, founder and CEO of Acclivity Health. “A practice would have to stand up a new entity, build governance and structure around that entity, and get participants to sign significant legal agreements. Then they had requirements related to documenting care, and more documentation related to communication between the ACO and participants. You had all these obstacles to overcome before you could even deliver the first penny in savings.”
Not only does the new model lighten up on the paperwork, but it also pays out more promptly than past models.
“This model takes a lot of that complexity and says, ‘That was eight years ago; we learned from all our efforts to evolve our medical model. Perhaps most importantly, we need to incentivize folks by giving them the opportunity to get reimbursed much differently. We required an 18-month investment with MSSP models. These new models reimburse participants in pre-payments that can exceed what they make today under Fee-For-Service contracts. Then, everything that they earn on top of that is based on how well they can produce clinical and financial outcomes,’” says Powell.
What About SIPs and Hospice Providers?
When it comes to Seriously Ill Populations, or SIPs, PCF could improve their care dramatically, since today primary care lags significantly behind hospitals for referrals to advanced care for these patients. They need a robust platform and robust processes to support them achieving these bonuses, and that system should create open channels of communication with advanced illness providers to streamline the care for their sickest patients.
Primary Care First seeks to create a continuum of care for this patient population and will accommodate a continuum of interested providers. From their founding, Acclivity Health has been focused on streamlining the care process for palliative care and hospice providers. The platform includes features to facilitate the care of SIPs, and to assist the providers who are caring for those populations. Some of these features include comparing patient data against similar cases to determine a more accurate prognosis, referring the costliest, most complex patients when their care requires it, and adding transparency to the end-of-life journey for patients and their families.
How PCF Works
According to CMS, “Primary Care First will focus on advanced primary care practices ready to assume financial risk in exchange for reduced administrative burdens and performance-based payments.”
PCF includes three payment models: one tailored to practices ready to assume financial risk in exchange for reduced administrative burdens and performance-based payments, another which promotes care for seriously ill population (SIP) beneficiaries who lack a primary care practitioner, and a third that allows practices to participate in both payment models. This variety means small practices, large practices, and entire health systems can participate in the program.
“It’s the next iteration of Alternative Payment Models, and it’s modeled after CPC+,” says Powell. “This one is probably even more simple than CPC+, upon which it is built. Participants will not be forced through a difficult, cumbersome process of documentation to be able to support outcomes. CMS will measure you against national benchmarks, regional benchmarks, and against specific controls. Then, as you perform well against those different measures, you achieve bonuses each quarter related to the benchmarks. There will be many winners and few losers in this program.”
Those winners aren’t just primary care practices — they’re hospice providers and SIP patients.
For hospices, PCF provides a financially viable model for reimbursing whole-person patient care for the nation’s most at-risk patients. Under these models, clinicians enrolled in Medicare who are already providing hospice or palliative care services will be able to provide care for SIP patients — either through the PCF general payment model option, or by partnering with a participating PCF practice. Hospices are more likely to be able to partner with providers who wish to enter these programs, but do not have the proper infrastructure in place to manage seriously ill patients in the same ways that established hospice providers can. This creates more opportunity for hospices and allows them to establish relationships with patients suffering from complex illnesses earlier in their disease trajectory.
How Acclivity Health Can Help
Practices using Acclivity Health technology are part of a connected care community of primary care, palliative care, and hospice providers, so criteria for the PCF payment models are easier to meet. Acclivity Health streamlines the five “aims” of the program:
1. Access and continuity
2. Care management
3. Comprehensiveness and coordination
4. Patient and caregiver engagement
5. Planned care and population health
“What these two programs are going to require in January have already been in place in our customer base for more than a year,” says Powell. “We manage all this great cross-pollination between what practices have to offer and what they have as gaps. We provide insight that is actionable to each clinician on the team to ensure we meet the family and patients where they are on their care journeys. We can point back to case studies where revenue has been created and where outcomes have been incredibly positive.”
Practices interested in using Acclivity Health’s connected care platform to help meet or exceed PCF’s standards are invited to call for more information.
We offer several “readiness services” for the Primary Care First and Seriously Ill Population programs including the following specific offerings:
• Governance and leadership structures
• Actuarial and analytical capabilities
• Clinical program development
• Network design and management
• Evidence-based care guideline creation and management
• APM design, contracting, and management
• Patient experience and engagement