Upcoming CMS program aims to ease primary care transition to value-based payment

Editor's note: This post was updated on July 25, 2023, with additional sources of information about the Making Care Primary program.

The Centers for Medicare & Medicaid Services (CMS) announced plans to launch a program next year to help primary care practices transition to value-based payments. Making Care Primary (MCP), a state-based, multi-payer model, will roll out July 2024 in eight test markets: Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, North Carolina, and Washington. CMS said practices in those states should be able to apply for the program later this summer. The agency is already working with the states to align their Medicaid payment systems with MCP, and plans to engage private payers as well in the months to come.

MCP builds on lessons from previous payment transformation models, including Comprehensive Primary Care and Comprehensive Primary Care Plus. It is a 10.5-year program unfolding in three stages that each focus on specific goals:

1. Building Infrastructure: Participants establish a foundation for implementing advanced primary care services such as patient risk stratification, data review, workflow development, chronic disease management, and social determinants of health screening and referral. Payment for primary care  remains fee-for-service (FFS) while CMS provides financial support to help participants develop infrastructure and build advanced care delivery capabilities. Participants begin earning financial rewards for improving patient health outcomes.
2. Implementing Advanced Primary Care: Participants partner with social service professionals and specialists, implement care management services, and screen for behavioral health conditions. Payment for primary care shifts to a 50/50 blend of prospective, population-based payments and FFS payments. CMS will continue some financial support for building advanced care delivery capabilities during this stage, even as participants are able to earn increased financial rewards for improving outcomes.
3. Optimizing Care and Partnerships: Participants begin 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. Compensation for primary care shifts to fully prospective, population-based payments while CMS continues minimal financial support to sustain care delivery activities. Participants can earn even greater financial rewards for improving patient health outcomes.

CMS has released additional resources on Making Care Primary on its website. All Items can be found in the “Additional Information” section of the MCP Model webpage, or directly through the following links:

• MCP Overview Factsheet
• MCP Payer Partner Factsheet
• MCP Overview Webinar Recording Part 1, Part 2, Part 3
• MCP Overview Webinar Transcript
• MCP Overview Webinar Slides

CMS will begin accepting applications for the model in late summer 2023. Organizations interested in applying for Making Care Primary may submit a non-binding Letter of Intent here. Questions may be directed to MCP@cms.hhs.gov.

For more information from the American Academy of Family Physicians (AAFP), read the AAFP’s press release, this AAFP News story, the “A Word from the President” blog, or the “In the Trenches” blog.

— Kate Freeman, AAFP Manager of Market Transformation

Posted on June 21, 2023