HHS Announces CMS Primary Cares Initiative

AAFP Payment Model Provided Inspiration, Guidance

April 24, 2019 02:27 pm News Staff

HHS plans to launch new payment models influenced, in part, by the AAFP's Advanced Primary Care Alternative Payment Model (APC-APM)(38 page PDF) and other physician input, with the intention of initiating valued-based transformation in primary care settings around the country.

[value-based care paper concept]

AAFP Vice Speaker Russell Kohl, M.D., of Stilwell, Kan., joined HHS Secretary Alex Azar, CMS Administrator Seema Verma, M.P.H., and Adam Boehler, director of CMS' Center for Medicare & Medicaid Innovation (CMMI), on stage in Washington, D.C., for the April 22 unveiling(www.youtube.com) of the models in the CMS Primary Cares Initiative.

Kohl said the initiative represents important movement toward acknowledging the vital role of primary care "by placing greater emphasis on the investments we make in family medicine and other primary care practices."

According to an HHS press release,(www.cms.gov) CMMI designed the models with considerable stakeholder input, including ideas put forth in the AAFP's APC-APM, which the Physician-Focused Payment Model Technical Advisory Committee had previously recommended(aspe.hhs.gov) that HHS begin testing.

Story Highlights
  • HHS unveiled the CMS Primary Cares Initiative at an April 22 press event in Washington, D.C.
  • The initiative will launch five test payment models that focus on paying for patient-centered value-based health care in primary care.
  • The payment models fall under two categories: Primary Care First and Direct Contracting.

"For years, policymakers have talked about building an American health care system that focuses on primary care, pays for value and places the patient at the center. These new models represent the biggest step ever taken toward that vision." said Azar in the press release. 

Verma was quoted in the same release: "Our Primary Cares Initiative is designed to give clinicians different options that advance our goal to deliver better care at a lower cost while allowing clinicians to focus on what they do best: treating patients."

Initiative Highlights

The CMS Primary Cares Initiative includes five payment models:

  • Primary Care First,
  • Primary Care First - High-need Populations,
  • Direct Contracting - Global,
  • Direct Contracting - Professional, and
  • Direct Contracting - Geographic.

The two Primary Care First models are designed to test whether financial risk and performance-based payments that reward primary care physicians and other clinicians will reduce total Medicare expenditures, maintain or enhance quality of care, and improve patient outcomes.

Furthermore, the high-need populations model will provide higher payments to practices that specialize in providing care to seriously ill patient populations and patients that have complex and chronic health care needs.

Both Primary Care First models will provide performance-based payment adjustments to physicians who reduce hospital utilization and total cost of care.

These two models focus on individual primary care practice sites and will be tested for five years beginning in January 2020; a second round of applications is scheduled for participants starting in January 2021.

The three Direct Contracting payment models also focus on transforming primary care by allowing physicians and other health care providers to take greater control of managing costs of care for an aligned population of Medicare fee-for-service beneficiaries.

However, these three models aim to draw in entities such as accountable care organizations, Medicare Advantage plans and Medicaid managed care organizations that have experience taking on financial risk and serving large patient populations.

Participants in these models will receive fixed monthly payments.

Additionally, organizations participating in the global payment model will bear full financial risk, and those in the professional payment model option will share risk with CMS.

Lastly, the geographic population-based model, with an expected launch date of January 2021, will ask organizations to assume the total cost of care and health needs of a population in a defined target region. CMS is seeking public comment(innovation.cms.gov) on this option.

AAFP Press Conference Comments

During his time at the podium, Kohl listed the four "Cs" of primary care, first defined by Barbara Starfield, M.D., M.P.H., as first contact with a patient followed by continuous, comprehensive and coordinated care.

Kohl said that since the publication of Starfield's research, "our health care system has systemically undervalued primary care."

To counteract this, he noted, the AAFP and other primary care organizations have been working for 20 years to create a delivery system that "rewards comprehensive and continuous patient-centered care" rather than episodes of care.

"For too long, we have approached delivery system reform as trying to identify systems that conformed to our already established payment system -- primarily fee-for-service," said Kohl.

However, the AAFP and others have grown to understand that fee-for-service "is largely incongruent with the best practices of advanced, patient-centered family medicine," he added.

Kohl said the episode-based incentives of fee-for-service payment must be eliminated, along with the administrative burdens that keep family physicians from taking care of patients unhindered.

"In short, it has become clear that we must create payment models that support our desired delivery models," Kohl said, noting that this "vision for primary care is what brings us together today."

As for next steps, the AAFP is initiating a deep-dive analysis of the details of the entire CMS Primary Cares Initiative and, in the near future, will offer an executive summary to help guide family physicians moving forward.

Related AAFP News Coverage
AAFP's Alternative Payment Model Wins Testing Recommendation
'It's Better for Our Country,' Says Committee Member

(12/19/2017)

More From AAFP
AAFP Welcomes New Primary Care Delivery and Payment Models
(4/22/2019)

In the Trenches blog: AAFP Payment Model Clears Another Hurdle
(4/3/2018)

Additional Resources
CMS Primary Cares Initiative fact sheet(innovation.cms.gov)

CMS Primary Care First fact sheet(www.cms.gov)  

CMS Direct Contracting fact sheet(www.cms.gov)