Washington to Participate in New CMS Primary Care Model
Earlier in June, the Centers for for Medicare & Medicaid Services (CMS) announced that Washington would be one of eight states to participate in Making Care Primary, or MCP. According to CMS, the new model aims to “improve care management and care coordination, equip primary care clinicians with tools to form partnerships with health care specialists, and leverage community-based connections to address patients’ health needs as well as their health-related social needs … such as housing and nutrition.”
A webinar on June 27 offered more details on the new model.
This model, developed by the CMS Innovation Center and modeled on recommendations by the National Academies report on implementing high-quality primary care, moves to prospective payments, reducing reliance on fee-for-service payments. This includes risk-adjusted enhanced services payments to allow for expanded care management, screen for social determinants, and integrate with specialty care.
Organizations will be eligible to participate in the MCP, not individual physicians. To be eligible, organizations must be authorized to conduct business in Washington (or one of the other participating states); be Medicare-enrolled; bill for health services for a minimum of 125 Medicare beneficiaries; and have a majority of their primary care clinical sites in an MCP state.
Organizations not eligible to participate include rural health clinics, concierge practices, grandfathered tribal FQHCs, or practices currently enrolled in certain other CMS projects (Primary Care First, ACO REACH). Those enrolled in other programs will have the chance to leave those programs if they wish to participate in Making Care Primary.
MCP will offer three tracks to best align organizations and their current capacity for MCP deliverables. Track 1 focuses on building infrastructure, Track 2 focuses on implementing advanced primary care, and Track 3 is about optimizing care and partnerships with social services and specialty care.
Besides Washington, MCP is also running in Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, and North Carolina.
MCP’s main webpage has more information; CMS has also produced a Frequently Asked Questions (FAQ) page for more detailed information.