Date

Fact sheet

Primary Care First Model Cohort 2 CY 2021 Fact Sheet

UPDATED: April 12, 2021

In January 2021, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMS Innovation Center) launched the Primary Care First (PCF) Model to test whether financial risk and performance-based payments that reward primary care practitioners for easily understood, actionable outcomes will reduce total Medicare expenditures, preserve or enhance quality of care, and improve patient health outcomes. CMS is announcing that the Primary Care First Model Cohort 2 Request for Applications (RFA) and Practice Application are now available.

Model Overview

Primary Care First is a voluntary alternative payment model that offers an innovative payment structure to support the delivery of high quality advanced primary care. PCF aims to foster independence for primary care practitioners through greater operating flexibilities and performance-based payments, enabling them to innovate the delivery of care based on their unique patient population and available resources. By tying patient health outcomes to the payments that participating practices receive, the model incentivizes clinicians to spend more time with patients and provide coordinated, comprehensive care.

Model Purpose

Primary care is central to a high-functioning healthcare system. There is an urgent need to preserve and strengthen primary care. Primary Care First prioritizes patients by emphasizing the clinician-patient relationship and increasing flexibility so practitioners can spend more time with patients and deliver care based on their needs. PCF aims to incentivize practitioners to address their beneficiaries’ chronic conditions early and comprehensively, mitigating the risk of costly hospital visits.

The PCF payment methodology is designed to provide a more predictable revenue stream than traditional Medicare fee-for-service and enable patient-focused care. Primary Care First focuses on advanced primary care practices that are ready to assume financial risk and performance-based payments.

Model Design

In response to input from primary care stakeholders, PCF is premised on the delivery of advanced primary care, including: prioritizing the clinician-patient relationship; enhancing care for patients with complex chronic needs, and focusing financial incentives on improved health outcomes.

Primary Care First aims to improve quality, enhance 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 will be determined by practice priorities. Practices will be incentivized to deliver patient-centered care that reduces acute hospital utilization. PCF is oriented around five comprehensive primary care functions: (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and (5) 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:
    1. A flat payment that encourages patient-centered care, and compensates practices for in-person treatment;
    2. A population-based payment to provide more flexibility in the provision of patient care; and
    3. 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 practice and other 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.

Participants and Locations

Primary Care First Model Options are 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).

Eligible practitioners (that each practice applicant must identify by NPI in its application) are those in internal medicine, general medicine, geriatric medicine, family medicine, and/or hospice and palliative medicine. CMS will conduct a program integrity screening on the practice and the practitioners that it intends to include in PCF. CMS may reject an application on the basis of the results of a program integrity screening.

CMS will also encourage other payers—including Medicare Advantage Plans, commercial health insurers, Medicaid managed care plans, and State Medicaid agencies—to align payment, quality measurement, and data sharing with CMS in support of Primary Care First practices.

Model Timeline

The PCF Cohort 2 Request for Applications is now available. The deadline for practices to apply for PCF Cohort 2 is May 21, 2021. The PCF Cohort 2 Request for Applications for payer partners is also now available. The deadline for payers to apply to partner with CMS in PCF Cohort 2 is June 18, 2021. Practices will begin participation in the model in January 2022. PCF Cohort 2 will have a five year performance period.

Resources and Support

Email: primarycareapply@telligen.com

Visit: https://innovation.cms.gov/initiatives/primary-care-first-model-options/

CMS Primary Cares Initiative: https://innovation.cms.gov/Files/x/primary-cares-initiative-onepager.pdf  

 

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