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CMS Unveils New Initiative to Overhaul Primary Care

This post has been updated with new information.

The Centers for Medicare and Medicaid Services (CMS) has released the CMS Primary Cares Initiative, with the goal of improving patient care while managing health care costs. Secretary of Health and Human Services Alex Azar described the move as “a historic turning point” in press reports. He also explained, “For years policymakers have talked about building an American health care system that focuses on primary care… These new models represent the biggest step ever taken toward that vision.  Building on the experience of previous models and ideas of past administrations, these models will test out paying for health and outcomes rather than procedures on a much larger scale than ever before. These models can serve as an inflection point for value-based transformation of our health care system, and American patients and providers will be the first ones to benefit.” 

The Primary Cares Initiative includes five new payment options for providers to boost management of patients with chronic illnesses and avert higher hospital costs. According to the HHS press release, it includes two pathways to improve care:

  • Primary Care First – This pathway will test financial risk and performance based payments for primary care providers through a monthly payment, which includes varying levels of payment based on a practice’s patient population, including high need patients with complex needs.   This pathway consists of two models: Primary Care First and Primary Care First – High Needs Populations.  This pathway is scheduled to go live January 2020 with a 5-year performance period.
  • Direct Contracting – This pathway allows providers to take greater control of managing costs of care for Medicare beneficiaries. It includes three payment options with varying levels of financial risk. The aim is to engage a wider variety of organizations who have experience taking a financial risk and serving larger local patient populations. CMS plans to launch the Direct Contracting models in January 2020 with an initial alignment year for organizations that want to align beneficiaries and performance periods will begin in 2021 and will be 5 years.


NACHC has confirmed that health centers are not eligible for all the options, but are able to participate in the “Direct Contracting Pathway.” 

Previous CMS officials are voicing support for the initiative, including Andy Slavitt, former CMS Administrator and Patrick Conway, former head of the Center for Medicare and Medicaid Innovation (CMMI), both with the Obama Administration.  You can also read a STAT article about the initiative by visiting this link.

This announcement is one of several recent announcements from CMMI.  In March they announced the creation of an emergency transportation demonstration, the “Emergency Triage, Treatment, and Transport (ET3) Program.”  This will be a 5-year demonstration program aimed at providing greater flexibility to ambulance care teams to address emergency health care needs of Medicare beneficiaries after a 911 call. The program will allow transport of an individual to an emergency room or alternative destination (such as a primary care provider or health center) or provide treatment in place with a qualified provider.  The Administration hopes that this demonstration will help to provide patients with better care, by granting alternative methods of care, instead of requiring that each ambulance go to the hospital. The demonstration is scheduled to go live January 2020.  Check out the CMS website on the demo if you are interested in learning more.

There are now multiple informational sessions being offered to learn more about Primary Care First initiative. Session information and registration links are included below:

Informational Session 1: Tuesday, April 30th at 12 PM EDT
Register to attend 

Informational Session 2: Tuesday, April 30th at 3 PM EDT
Register to attend 

Informational Session 3: Thursday, May 16th at 12 PM EDT
Register to attend

Informational Session 4: Thursday, May 16th at 3 PM EDT
Register to attend

Feel free to forward this invitation to colleagues who may be interested in learning more about the Primary Care First Model. Reference materials will also be available for download during the event. For additional information about Primary Care First, please visit the model website at https://innovation.cms.gov/initiatives/primary-care-first-model-options/

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS16089, Technical Assistance to Community and Migrant Health Centers and Homeless for $6,375,000.00. This information or content and conclusions are those of theauthor and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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