April 25th, 2019
Categories: Benefits of HBPC

Risk - Reward Model Graphic

  • CMS on Monday announced a new voluntary Medicare payment model for primary care providers. The two-pronged program has paths for small practices and large organizations and a range of options from partial shared risk to full downside risk.
  • The agency projects as many as a quarter of traditional Medicare fee-for-service beneficiaries will be incorporated into the five-year program, called Primary Cares Initiative. It is slated to roll out in January, with a call for applications expected in about a month.
  • CMS is also asking for input on an additional model in the program that would give one organization responsibility for the total cost of care for an entire Medicare population in a geographic area. That model would begin in January 2021.

Center for Medicare and Medicaid Innovation Director Adam Boehler noted in a press conference unveiling the model that primary care makes up only a small fraction of the country’s total healthcare spend (and of Medicare spending), but emphasized its potential to have great affect on downstream costs and quality outcomes.

“A strong primary care foundation is essential to an effective healthcare system broadly,” Boehler said.

HHS Secretary Alex Azar said the Primary Cares Initiative represented a pivotal moment for the agency as it pushes providers toward value-based care arrangements, and he hoped the Medicare program would have ripple effects. “This initiative is specifically designed to encourage state Medicaid programs and commercial payers to adopt similar approaches,” he said at the press conference. Read the full article