CMS Announces New Value-based Payment Models for Primary Care

The CMS Innovation Center recently announced the Primary Cares Initiative, which will provide primary care practices and other providers with five new payment model options under two paths – Primary Care First (PCF) and Direct Contracting (DC). The PCF model options are focused on individual primary care practice sites, while the DC 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.  The PCF options will be tested for five years beginning in January and incentivize providers to reduce hospital use and total cost of care through performance-based payment adjustments. The DC model options focus on care for patients with complex, chronic needs and serious illness and provide prospective model participants a range of financial risk arrangements, CMS said. The agency also released a request for information seeking comment on one of the DC models. All of the payment model options are expected to qualify in 2021 as Advanced Alternative Payment Models under Medicare’s Quality Payment Program for clinicians.

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