CMS Primary Care Initiative provides new payment models

Primary care practices and other health care providers will soon be able to use five new payment models under a federal effort to deliver better value for patients.

The U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) recently announced the CMS Primary Care Initiative, which creates the new payment models under two paths: Primary Care First (PCF) and Direct Contracting (DC). The five payment model options are:

• PCF
• PCF - High Need Populations
• DC – Global
• DC – Professional
• DC – Geographic

While the PCF models are focused on individual primary care practice sites, the DC payment model options aim to engage a wider variety of organizations that have experience taking on financial risk and serving larger patient populations, such as accountable care organizations, Medicare Advantage plans, and Medicaid managed care organizations.

CMS anticipates these five payment model options could affect more than a quarter of all Medicare beneficiaries and offer new participation and payment options and opportunities for an estimated 25 percent of primary care physicians and other health care providers. The initiative could also create new coordinated care opportunities for a large portion of the up to 12 million beneficiaries who are dually eligible for Medicare and Medicaid – specifically those in Medicaid managed care and Medicare fee-for-service.

For More Information:

• Primary Care First Fact Sheet
• Direct Contracting Fact Sheet

– Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians