News: CMS announces five, new, risk-based primary care payment models

Earlier this week, CMS announced the introduction of the CMS Primary Cares initiative, a voluntary, risk-based initiative to transform primary care to a value-based system that rewards physicians who keep patients healthy and out of the hospital, HealthLeaders Media reported.

“The initiative will dramatically elevate the importance of primary care in American medicine, move forward a system where providers are paid for outcomes rather than procedures, and free up doctors to focus on the patient in front of them, rather than the paperwork we send them,” said Health and Human Services (HHS) Secretary Alex Azar during a press briefing at the American Medical Association on Monday, according to MedPage Today.

The initiative has multiple models along with two tracks that will enroll at least a quarter of traditional Medicare beneficiaries, according to Azar.

The first track, Primary Care First—High Need Populations will offer more money to those practices with complex, chronic needs and seriously ill patient populations, and pay practices a total monthly payment, according to HealthLeaders Media. This track will be geared toward smaller practices.

The second track, Direct Contracting, will be geared toward larger practices with more experience taking risks, such as accountable care organizations, Medicare Advantage plans, and Medicaid managed care organizations. When patients are healthy, the practices in this track will be paid more, but if patients get sicker, the practices will bear the responsibility for extra health spending, according to Azar.

“Despite only being 2% to 3% of spend, primary care providers have an enormous influence over downstream costs,” said Adam Boehler, director of CMS Center for Innovation. “Our current payment systems do not recognize the essential role that primary care providers pay. We’re going to change that today.”

The application period for both tracks is expected to open this spring with the initiative launching over the course of 2020 and 2021.

Editor’s note: To read HealthLeaders Media’s coverage of this story, click here. To read MedPage Today’s coverage, click here.