On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new voluntary primary care model – the Making Care Primary (MCP) Model – that will be tested in eight states. Launching July 1, 2024, the 10.5-year model will improve care management and care coordination, equip primary care clinicians with tools to form partnerships with health care specialists, and leverage community-based connections to address patients’ health needs as well as their health-related social needs (HRSNs) such as housing and nutrition. CMS is working with State Medicaid Agencies in eight states – Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts and Washington – to engage in full care transformation across payers, with plans to engage private payers in the coming months.
The Making Care Primary (MCP) Model is a 10.5-year multi-payer model with three participation tracks that build upon previous primary care models, such as the Comprehensive Primary Care (CPC), CPC+, and Primary Care First (PCF) models, as well as the Maryland Primary Care Program (MDPCP). MCP aims to improve care for beneficiaries by supporting the delivery of advanced primary care services, which are foundational for a high-performing health system. The MCP Model will provide a pathway for primary care clinicians with varying levels of experience in value-based care to gradually adopt prospective, population-based payments while building infrastructure to improve behavioral health and specialty integration and drive equitable access to care. State Medicaid agencies will commit to designing Medicaid programs to align with MCP in key areas. This model will attempt to strengthen coordination between patients’ primary care clinicians, specialists, social service providers, and behavioral health clinicians, ultimately leading to chronic disease prevention, fewer emergency room visits, and better health outcomes.
Primary care clinicians are the first line of defense for prevention, screening, management of chronic conditions, and overall wellness. Patients are increasingly diagnosed with multiple chronic conditions, which only intensifies the importance of accessible, affordable, high-quality primary care teams that can help anchor their overall health care. However, care coordination is increasingly challenging as patients see a greater number of specialists more frequently. Through MCP, the Center for Medicare and Medicaid Innovation (the Innovation Center) increases the investment in primary care so patients can access more seamless, high-quality, whole-person care.
The MCP Model meets primary care organizations where they are through its progressive, three-track approach to begin transforming care and improving outcomes for their patients. This includes several payment innovations to support participants in delivering advanced primary care. To support team-based care, MCP will include prospective payments for primary care that will reduce organizations’ reliance on fee-for-service payments. Risk-adjusted enhanced services payments, which will also be paid prospectively and represent an additional investment in primary care, will allow participants to expand care management, screen for health-related social needs, and integrate with specialty care. MCP will include Federally Qualified Health Centers (FQHCs) in a multi-state advanced primary care model for the first time, as well as other organizations serving Medicare beneficiaries with complex health and social needs to further this goal. For these participants, the model features upside-only performance incentives that will allow participants to be rewarded for their work to improve quality and cost outcomes for their patients. The quality performance measures included in MCP reflect the work of CMS to streamline measures across programs and test new and innovative measures.
The MCP care delivery approach communicates its vision for care delivery through three domains:
- Care Management: participants will build their care management and chronic condition self-management support services, placing an emphasis on managing chronic diseases such as diabetes and hypertension, and reducing unnecessary emergency department (ED) use and total cost of care.
- Care Integration: in alignment with CMS’ Specialty Integration Strategy, participants will strengthen their connections with specialty care clinicians while using evidence-based behavioral health screening and evaluation to improve patient care and coordination.
- Community Connection: participants will identify and address health-related social needs (HRSNs) and connect patients to community supports and services.
Each of these domains has specific care delivery requirements for participating organizations in each track.
MCP’s three progressive tracks are designed to recognize participants’ varying experience in value-based care—from under-resourced participants to those with existing advanced primary care experience in alternative payment models. MCP aims to give these organizations flexibility, allowing them to choose their participation track and receive payments that reflect each participant’s experience towards accountable care. Again, MCP is a three-track model with one track reserved for organizations with no prior value-based care experience.
- Track 1 –Building Infrastructure: Participants will begin to develop the foundation for implementing advanced primary care services such as risk-stratifying their population, reviewing data, building out workflows, identifying staff for chronic disease management, and conducting health-related social needs screening and referral. Payment for primary care will remain fee-for-service (FFS), while CMS provides additional financial support to help participants develop care transformation infrastructure and build advanced care delivery capabilities. Participants can begin earning financial rewards for improving patient health outcomes in this track.
- Track 2 – Implementing Advanced Primary Care: As participants progress to Track 2, they will build upon the Track 1 requirements by partnering with social service providers and specialists, implementing care management services, and systematically screening for behavioral health conditions. Payment for primary care will shift to a 50/50 blend of prospective, population-based payments and FFS payments. CMS will continue to provide additional financial support at a lower level than Track 1, as participants continue to build advanced care delivery capabilities. Participants will be able to earn increased financial rewards for improving patient health outcomes.
- Track 3 – Optimizing Care and Partnerships: In Track 3, participants will expand upon the requirements of Tracks 1 and 2 by using quality improvement frameworks to optimize and improve workflows, address silos to improve care integration, develop social services and specialty care partnerships, and deepen connections to community resources. Payment for primary care will shift to fully prospective, population-based payment while CMS will continue to provide additional financial support, at a lower level than Track 2, to sustain care delivery activities while participants have the opportunity to earn greater financial rewards for improving patient health outcomes.
To be eligible to apply to participate in MCP, an organization must:
- Be a legal entity formed under applicable state, federal, or Tribal law authorized to conduct business in each state in which it operates.
- Be Medicare-enrolled.
- Bill for health services furnished to a minimum of 125 attributed Medicare beneficiaries.
- Have the majority (at least 51%) of their primary care sites (physical locations where care is delivered) located in an MCP state.
Rural Health Clinics, concierge practices (practices that collect a fee from patients for access to their services), current Primary Care First (PCF) practices, current ACO REACH Participant Providers, and Grandfathered Tribal FQHCs are not eligible for MCP. Organizations will not be able to concurrently participate in the Medicare Shared Savings Program and MCP after the first six months of the model.
State Participation in MCP
Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, North Carolina, and Washington were selected after reviewing criteria related to geographic diversity, health equity opportunity, population, current CMS Innovation Center footprint, generalizability to the rest of the Medicare population for model evaluation, and the ability to align with state Medicaid agencies. CMS will provide further details about state-specific eligibility criteria for applicants in the Request for Applications (RFA).
We are partnering with state Medicaid agencies and other payers in the listed MCP states to align MCP and state programs. While CMS is implementing MCP for Medicare beneficiaries as described in the RFA, other payers are encouraged to partner with CMS to realize the goals and elements of improved primary care across all patients, including those covered by Medicaid, commercial, and other payers.
Health Equity Strategy
The Innovation Center believes that equitable care is crucial to achieving high-quality care for Medicare and Medicaid beneficiaries and is, therefore critical to MCP’s success. CMS defines health equity as: “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.” The term “underserved communities” refers to populations sharing a particular characteristic, as well as geographic communities, that have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life (more information).
MCP includes several model components designed to improve health equity:
- Some payments will be adjusted by clinical indicators and social risk.
- Participants will be required to develop a strategic plan for how they will identify disparities and reduce them.
- Participants will be required to implement HRSN screening and referrals.
- Participants will be allowed to reduce cost-sharing for patients in need.
- CMS will measure the percentage of patients screened for HRSNs
- CMS will collect data on certain demographic information and HRSNs to evaluate health disparities in MCP communities.
- MCP Applicant Office Hour - August 21, 2023 - Slides (PDF) | Transcript (PDF) | Recording (MP4)
- MCP Payer Office Hour - August 8, 2023 - Slides (PDF) | Transcript (PDF) | Recording (MP4)
- Making Care Primary (MCP) FQHC and Indian Health Program Overview Webinar - July 20, 2023 - Slides (PDF) | Transcript (PDF) | Recording (MP4)
- MCP Model Overview Webinar - June 27, 2023 - Slides (PDF) | Transcript (PDF) | Recording - Part 1 (MP4), Part 2 (MP4), Part 3 (MP4)
- MCP Request for Applications (RFA) (PDF)
- MCP Model Applicant Letter of Intent
- MCP Model Frequently Asked Questions
- MCP Overview Factsheet (PDF)
- MCP Payer Partner Factsheet (PDF)
- MCP Application Tracks Factsheet (PDF)
- MCP Payer Partners Guide to Alignment (PDF)
- CMS Innovation Center Primary Care Models Comparison