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Primary Care First Model

There is a new initiative from CMS called Primary Care First Model. This model rewards value and quality by offering an innovative payment structure to support delivery of advanced primary care. It’s based on the underlying principles of the existing CPC+ model design: prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes.

Practices will be incentivized to deliver patient-centered care that reduces acute hospital utilization. 

Primary Care First is oriented around 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 payment to practices through a simple payment structure, including:

     1. a payment mechanism that allows care to be driven by clinicians rather than administrative requirements and revenue cycle management;

     2. a population-based payment to provide more flexibility in the provision of patient care along with a flat primary care visit fee; and

     3. a performance-based adjustment providing an upside of up to 50% of revenue as well as a small downside (10% of revenue) incentive to reduce costs and improve quality, assessed and paid quarterly.

· Providing practice participants with performance transparency, through practitioner-identifiable information on their own and other practice participants’ performance to enable and motivate continuous improvement.

In Primary Care First, CMS will use a focused set of clinical quality and patient experience measures to assess quality of care delivered at the practice. A Primary Care First practice must meet standards that reflect quality care in order to be eligible for a positive performance-based adjustment to their primary care revenue. These measures were selected to be actionable, clinically meaningful, and aligned with CMS’s broader quality measurement strategy. Measures include a patient experience of care survey, controlling high blood pressure, diabetes hemoglobin A1c poor control, colorectal cancer screening, and advance care planning.

MedLink Advantage is an ACO Management and Healthcare Consulting Company looking to assist providers in this new program, especially independent practices that would like to remain independent. Medlink Advantage has a proven track record of success.  We offer, application processing, HIPAA compliant data storage, customized reports designed to assist you with your population management, reports that identify high risk individuals and much more.  Medlink Advantage can provide your primary care practitioners with a cost risk assessment of this Primary Care First Model initiative to see if this initiative would be beneficial.  If you would like additional information regarding this new CMS initiative or know of any practices that would like to participate in this program, but didn’t think they had the resources or expertise to enroll, please let me know.

Here is a link from the AMA regarding this new CMS initiative.

Here is also the CMS website link to the Primary Care First Model:

If you would like additional information, please call Jean at 8886009263 ext 101