Making Care Primary Model Introduction
The Centers for Medicare & Medicaid Services (CMS) recently launched the Making Care Primary (MCP) Model, a pilot program to improve primary care services in select states. The MCP Model focuses on enhancing care management and coordination while addressing patients’ health-related social needs. The MCP Model strives to boost quality of care while reducing expenses for the benefit of patients and healthcare professionals.
Integrated, Coordinated, Person-Centered Primary Care
The MCP Model emphasizes providing integrated, coordinated, person-centered primary care. This ensures that all individuals receive timely access to appropriate medical services tailored to their unique needs and preferences. MCP encourages collaboration between healthcare professionals, fostering an environment where everyone works together toward achieving optimal patient outcomes.
TRANSFORM CARE INTO VALUE
Improve Outcomes and Care Efficiency
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Objectives Outlined by CMS
- Ensure patients receive integrated, coordinated, person-centered primary care.
- Create pathways for smaller or independent primary-care organizations to enter value-based arrangements.
- Improve patient outcomes while reducing overall healthcare expenditures.
Additional Revenue Sources
- CMS will provide participants with additional revenue sources, which can be used towards building the infrastructure necessary for enhancing the accessibility of primary-care services and better coordinating with specialists.
- CMS anticipates downstream savings over time through improved preventive measures, leading ultimately towards lower avoidable costs such as repeat hospitalizations.
Promising Initiative
The MCP Model is a promising initiative that has the potential to transform primary care delivery in the United States and improve overall patient outcomes. Learn more about the MCP Model and how it’s changing the healthcare landscape.
Goals of the MCP Pilot Program
The Centers for Medicare & Medicaid Services (CMS) has outlined three main goals for the Making Care Primary (MCP) pilot program. These objectives aim to enhance primary care services and improve patient outcomes while reducing healthcare costs.
Integrated and Coordinated Primary Care
The first goal is ensuring patients receive integrated, coordinated, person-centered primary care. This means that healthcare providers will work together to address patients’ medical and health-related social needs. Clinicians can strive to gain a more comprehensive perspective of each patient’s situation and formulate individualized treatment plans accordingly.
Pathways into Value-Based Arrangements
MCP also aims to create pathways for smaller or independent primary-care organizations to enter value-based care arrangements with CMS. Value-based care emphasizes improving patient outcomes while controlling costs by rewarding providers based on their performance rather than the volume of services they deliver. This shift in focus encourages healthcare professionals to prioritize quality over quantity when treating patients.
Improved Quality of Care and Reduced Expenditures
- Better Coordination: The MCP Model promotes improved communication between various patient healthcare team members, leading to more effective treatment strategies.
- Data-Driven Decision-Making: Participating organizations will have access to data analytics tools that help identify areas where improvements can be made in both clinical practice and administrative processes (source).
- Preventive Care: By emphasizing preventive measures, the MCP Model aims to reduce avoidable healthcare costs such as repeat hospitalizations and emergency room visits.
In summary, the goals of the MCP pilot program are designed to enhance primary care services while promoting value-based arrangements and reducing overall healthcare expenditures. This innovative approach holds promise for improving patient outcomes and transforming primary care delivery in participating states.
MCP's Impact on Healthcare Infrastructure
The Making Care Primary (MCP) Model aims to revolutionize the healthcare infrastructure in participating states. By providing additional revenue sources for primary care providers, MCP enhances accessibility and coordination of primary-care services with specialists. This approach improves patient outcomes and reduces healthcare costs by addressing avoidable expenses such as repeat hospitalizations.
Additional Revenue Streams
One of the key components of the MCP model is its ability to provide participants with new funding opportunities. These funds can be used towards building the essential infrastructure needed for enhancing accessibility within their communities. For example, CMS data shows that increased investment in primary care leads to better health outcomes and lower healthcare expenditures over time.
Enhanced Accessibilities
- Better technology: With more resources available through MCP, primary care organizations can invest in advanced technologies like telehealth services or electronic health records systems, making it easier for patients to receive timely and efficient care.
- Innovative service delivery models: The additional funding from MCP allows providers to explore innovative ways of delivering high-quality care while reducing barriers underserved populations face.
- Care coordination: Improved communication between different types of healthcare professionals ensures seamless transitions across various levels of care within the system – ultimately leading to improved patient experiences and outcomes.
Better Coordination Between Specialists
An integral part of improving our nation’s healthcare system is fostering collaboration among all medical professionals involved in a patient’s journey. Primary care providers can establish stronger connections with specialists and other healthcare organizations through the MCP model. This collaboration allows for better coordination of patient care and more effective management of complex medical conditions. Patients are provided optimal care when necessary, leading to fewer hospital stays and decreased expenditures.
States Participating in the Pilot Program
These states were chosen based on their commitment to enhancing primary care services and willingness to participate in innovative healthcare models. The initial participating states include:
- Colorado
- Massachusetts
- Minnesota
- New Jersey
- New Mexico
- New York
- North Carolina
- Washington
By focusing on these specific regions, CMS aims to create a diverse representation of primary-care organizations that can serve as a model for future expansion nationwide.
Each state will work closely with CMS throughout the pilot program, ensuring successful implementation and evaluation of its impact on patient outcomes and overall healthcare costs. This collaboration between federal agencies and state governments highlights the importance of multi-level cooperation when addressing complex health-related issues.
If your organization operates within one of these participating states, stay informed about MCP developments and consider applying when applications open in late summer 2023. By joining this pilot program, you can play an essential role in transforming primary care delivery while benefiting from additional revenue streams provided by CMS.
To learn more about each state’s involvement in the MCP Model or explore resources available for interested providers, visit their health department websites linked above. Stay tuned for updates on additional states that may join the pilot program.
Multi-Payor Alignment Strategy
The MCP Model is designed with a flexible multi-payor alignment strategy in mind. This approach allows CMS to build on existing state innovations, ensuring that all patients served by participating clinicians benefit from improvements in care delivery, financial investments, learning tools, and resources. This model aims to create a more efficient and effective primary care system by leveraging the power of collaboration between various payors and healthcare providers.
Building on existing state innovations, the MCP Model encourages states to share best practices and lessons learned from their value-based payment programs. This collaborative approach helps drive innovation nationwide while reducing duplication of efforts.
Benefits of the MCP Model
- Improvements in care delivery: The multi-payor alignment strategy enables primary-care organizations to better coordinate patient care through shared data systems and standardized quality measures. This results in improved patient health outcomes and reduced healthcare costs.
- Financial investments: Participating organizations receive enhanced payments under the MCP Model, which can be used towards building infrastructure necessary for enhancing accessibility of primary-care services and better coordinating with specialists.
- Learning tools & resources: To support continuous improvement among participants, CMS provides access to valuable educational materials such as webinars, toolkits, case studies, and other resources to foster success within the program.
In addition to these benefits provided by the multi-payor alignment strategy, the Making Care Primary (MCP) Model presents an opportunity for smaller or independent primary-care organizations looking to enter value-based care arrangements. By offering a more accessible pathway into these innovative payment models, the MCP Model can help drive widespread adoption of value-based care and improve overall healthcare quality for patients nationwide. So, let’s get aligned and make primary care great again.
Progressive Three-Track Approach
The MCP Model uses a three-track approach based on participants’ experience level with value-based care and alternative payment models. This innovative method allows primary-care organizations to enter the program at different stages, depending on their current capabilities and readiness for change.
All tracks receive enhanced payments, which help support the development of necessary infrastructure for improving patient care. The main differences between the tracks lie in their focus areas and potential rewards:
- Track One: Infrastructure Development – Designed for organizations new to value-based care or needing additional support in building essential systems, Track One focuses on providing resources and guidance for transforming primary-care services. Participants will receive upfront funding to invest in technology, staff training, data analytics tools, and other critical components needed for success.
- Tracks Two & Three: Advance Payments & Bonuses – Aimed at more experienced providers who have already made progress towards implementing value-based arrangements, Tracks Two and Three offer greater financial incentives tied directly to performance outcomes. In addition to receiving advance payments based on projected savings from improved patient care coordination efforts, participating organizations can also earn bonus payments if they meet specific quality metrics or demonstrate cost reductions over time.
This tiered system encourages continuous improvement by rewarding healthcare providers who achieve better results while offering ample opportunities for newcomers to learn from best practices within the industry. By incorporating performance-based incentives into its design, the MCP Model paves the way toward achieving high-quality person-centered primary care across all levels of expertise.
Application Process and Launch Date
The application process for primary care organizations within participating states will open in late summer 2023, with the Making Care Primary (MCP) Model launching on July 1st, 2024. This timeline allows ample time for the preparation and implementation of this innovative pilot program.
To participate in the MCP Model, healthcare providers must meet specific eligibility criteria outlined by CMS. These include being a Medicare-certified primary care organization, having an established patient population that meets certain requirements, and demonstrating a commitment to improving the quality of care through value-based arrangements.
Interested organizations can prepare their applications by reviewing the detailed Making Care Primary Request for Applications (RFA). The RFA contains essential information about eligibility criteria, required documentation, performance metrics, payment models, and more. To further support applicants during this process:
- CMS will host informational webinars explaining key aspects of the model;
- Technical assistance resources will be available;
- A dedicated email address has been established to answer questions from potential participants: MCPModel@cms.hhs.gov.
In addition to applying directly through CMS’s website when it becomes available in late summer 2023, CMS aims to ensure that all participating organizations have the necessary time and resources to successfully transition into this new model of care by providing a generous timeline for application and implementation. This will ultimately lead to better patient outcomes, improved accessibility, and reduced healthcare costs across the eight selected states.
FAQs
The MCP Model is a pilot program designed to improve primary care services. The goal is to make primary care more integrated, coordinated, person-centered, and accountable. It aims to improve the quality of care and health outcomes of patients while reducing program costs.
The MCP Model is being managed by the Center for Medicare and Medicaid Innovation, under the Centers for Medicare & Medicaid Services (CMS).
The pilot program will begin on July 1, 2024, and it will initially be launched in eight states: Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington.
The pilot program will run for a little over a decade, until December 31, 2034.
The MCP Model provides participants with additional revenue to build infrastructure, make primary care services more accessible, and better coordinate care with specialists. It is especially beneficial for small, independent, rural, and safety-net organizations, helping them to enter into value-based care arrangements.
The MCP Model focuses on improving care management and care coordination, equipping primary care clinicians with tools to form partnerships with healthcare specialists, and partnering with community-based organizations. This approach is expected to help patients better manage their health conditions and reach their health goals.
The MCP Model utilizes a progressive three-track approach based on participants’ experience level with value-based care and alternative payment models.
The long-term goal is to reach 100% of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care arrangements, including advanced primary care, by 2030.
Conclusion
Improving primary care is essential for better patient outcomes and lower healthcare costs, and the MCP Pilot Program is leading the way by integrating and coordinating primary care, creating pathways to value-based arrangements, and improving care quality while reducing expenses.
The program’s impact on healthcare infrastructure includes additional revenue streams, enhanced patient accessibility, better coordination between specialists, and more, with multi-payor alignment strategies to build on existing state innovations and improve care delivery and financial investments.
The progressive three-track approach offers incentives for infrastructure development with advance payments and bonuses based on performance metrics, and the application process is open now, with launch dates to be announced soon.
