ACP: New Alternative Payment Model Better Supports Internal Medicine Physicians

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The Making Care Primary Model offers on-ramp to value-based care, focuses on health equity and includes behavioral and specialty care integration

Sept. 22, 2023 (ACP) — The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI) is rolling out a new value-based payment model designed to better support primary care physicians in caring for their patients and reflects many ongoing advocacy priorities of the American College of Physicians.

The passage of the Medicare Access and CHIP Reauthorization Act of 2015 and implementation of the Medicare Quality Payment Program created a new pathway for physicians that aim to shift payment from volume to value. Programs such as Comprehensive Primary Care Plus, Primary Care First and the Accountable Care Organization Realizing Equity, Access, and Community Health Model are some of the most well-known Alternative Payment Models (APMs).

The newest APM, known as the Making Care Primary (MCP) Model, was announced on June 8 and is slated to officially launch on July 1, 2024. It will operate in eight states: Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, North Carolina and Washington.

“This model champions and supports primary care physicians as being a driver of improved health outcomes, increased access to services and decreased hospitalizations for their patients,” said Sarah Crossan, ACP associate for regulatory affairs.

The new model will offer many features that make it an accessible on-ramp for primary care doctors who do not have prior value-based payment experience, Crossan explained. MCP offers three progressive tracks, including: building infrastructure; implementing advanced primary care; and optimizing care and partnerships.

These tracks are designed to recognize practices' varying experiences in value-based care. While track 1 serves as a gateway for participants who do not have prior experience with value-based care, greater financial incentives are attainable as participants take more risks and gain familiarity with the model.

“Participants are offered increased flexibility in a model which allows them to progress as they build infrastructure to provide advanced primary care,” Crossan said.

MCP is also launching with a 10.5-year time frame. “Previous CMMI models have had shorter program lengths, so this is of great benefit to participants,” Crossan said.

The longer period will allow participants more time to get to know how the model works, adjust to its requirements and provide CMS with a greater opportunity to demonstrate overall program savings and model stability. “The extended program length is the product of many years of ACP advocacy and is a feature we hope to see continued in other CMMI models,” Crossan noted.

In addition, the model contains elements designed to promote health equity, which is something ACP has long championed, Crossan said. Participants will be required to develop a strategic plan for how they will identify and reduce disparities, and they will be permitted to reduce cost-sharing for patients in need, among other adjustments.

Behavioral and specialty care integration are additional features of the MCP Model design. Primary care participants will be required to strengthen their relationships with specialty care clinicians and incorporate evidence-based behavioral health screening and evaluation to improve patient care and coordination, Crossan said.

CMS has released a Request for Applications, and interested applicants may apply through the Application Portal, which opened on Sept. 4 and closes on Nov. 30.

More information will be presented during a webinar on Sept. 27, 2023. Leaders from ACP, the American Medical Association and the American Academy of Family Physicians, along with staff from CMS and the CMMI, will be available to discuss the model. “This will allow members to ask questions such as ‘What track is the best fit for my practice?’; ‘What will MCP's multi-payer alignment look like?’; and ‘When can we expect to have more details on these partnerships?’” Crossan said.

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Back to the September 22, 2023 issue of ACP Advocate