Making Care Primary (MCP) Model

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 was tested in eight states. Launching July 1, 2024, the 10.5-year model aimed to 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 worked 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.

Model Overview 

The Making Care Primary (MCP) Model was a 10.5-year multi-payer model with three participation tracks that built 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 aimed 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 provided 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 increase access to care. State Medicaid agencies committed to designing Medicaid programs to align with MCP in key areas. This model attempted 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. 
 

Model Purpose

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) increased the investment in primary care so patients could access more seamless, high-quality, whole-person care. 
 
The MCP Model met primary care organizations where they were through its progressive, three-track approach to begin transforming care and improving outcomes for their patients. This included several payment innovations to support participants in delivering advanced primary care. To support team-based care, MCP included prospective payments for primary care that would reduce organizations’ reliance on fee-for-service payments. Risk-adjusted enhanced services payments, which were paid prospectively and represent an additional investment in primary care, allowed participants to expand care management, screen for health-related social needs, and integrate with specialty care. MCP included 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 featured upside-only performance incentives that allowed 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 communicated its vision for care delivery through three domains:

• Care Management: participants built 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 strengthened their connections with specialty care clinicians while using evidence-based behavioral health screening and evaluation to improve patient care and coordination. 
   
• Community Connection: participants identified and addressed health-related social needs (HRSNs) and connected patients to community supports and services.

Each of these domains had specific care delivery requirements for participating organizations in each track.

Model Design

MCP’s three progressive tracks were 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 aimed 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 was a three-track model with one track reserved for organizations with no prior value-based care experience. 

• Track 1 – Building Infrastructure: Participants began 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 remained fee-for-service (FFS), while CMS provided additional financial support to help participants develop care transformation infrastructure and build advanced care delivery capabilities. Participants could begin earning financial rewards for improving patient health outcomes in this track.
   
• Track 2 – Implementing Advanced Primary Care: As participants progressed to Track 2, they would 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 would shift to a 50/50 blend of prospective, population-based payments and FFS payments. CMS would have continued to provide additional financial support at a lower level than Track 1, as participants continued to build advanced care delivery capabilities. Participants would have been able to earn increased financial rewards for improving patient health outcomes. 
   
• Track 3 – Optimizing Care and Partnerships: In Track 3, participants would have expanded 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 would shift to fully prospective, population-based payment while CMS would have continued to provide additional financial support, at a lower level than Track 2, to sustain care delivery activities while participants would have had the opportunity to earn greater financial rewards for improving patient health outcomes.

Eligibility Criteria

To be eligible to apply to participate in MCP, an organization needed to:    

• 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 were not eligible for MCP. Organizations were not 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 provided further details about state-specific eligibility criteria for applicants in the Request for Applications (RFA).