The Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) have unveiled the Primary Cares Initiative (PCI), which includes 5 payment models and 2 types of financial incentives. The 5 payment models include: Primary Care First; Primary Care First – High Need Populations; Direct Contracting – Global; Direct Contracting – Professional; and Direct Contracting – Geographic; all set to start January 2020 with the exception of Direct Contracting – Geographic, which is set to start mid-2020.
Primary Care First Model Options
The Primary Care First model includes two options: 1) Primary Care First, which provides payment to practices via a simplified total monthly payment allowing clinicians to focus on patient care vs. revenue; and, 2) Primary Care First – High Need Populations, which provides practices that specialize in care for patients with complex, chronic needs or who are seriously ill with higher payments. Both options will get performance-based payment adjustments depending on the outcomes on clinical quality measures by PCPs.
Direct Contracting Model Options
The Direct Contracting model includes three options: 1) Direct Contracting – Global, which means participants will bear 100% financial risk; 2) Direct Contracting – Professional, in which participants will share the risk (50/50) with the CMS; and, 3) Direct Contracting – Geographic, which gives organizations the opportunity to assume responsibility including the total primary care cost and health needs for communities within a particular region. All three options create a “competitive delivery system environment” and allow for a more predictable revenue stream.
Purpose of 5 Payment Models
The overall purpose of these 5 payment models is to determine if financial risk and performance-based payments reduce the cost, keep or improve quality of care and outcomes. “This is the first step to building an American Healthcare System that focuses on primary care, pays for value, and places the patient first,” said HHS Secretary Alex Azar.
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