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The Centers for Medicare and Medicaid Services (CMS) recently unveiled the Making Care Primary (MCP) Model - a primary care-focused project designed to strengthen the basis of primary care and meet community needs. This model marks a fundamental change in how CMS approaches value-based care (VBC) and has the potential to significantly improve health outcomes. The multistate initiative focused on bolstering primary care is scheduled to start on July 1,2024, with a planned duration of 10.5 years. The testing of the MCP Model will take place across eight states, including Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington.
The program's scope includes traditional Medicare beneficiaries and its primary goal is to reinforce primary care infrastructure. This will be achieved through improvements in service delivery, care integration, and enhancing the MCP entity's care management programs. Additionally, the program aims to integrate specialty care effectively and establish stronger connections with community support to address gaps related to social determinants of health.
This blog will provide a comprehensive discussion on various aspects of the MCP Model, including its objectives, different tracks, payment mechanisms, program timetable, and what it indicates for the future of primary care.
What are the Goals of the Making Care Primary (MCP) Program?
The model will draw upon the foundations of previous primary care models, including the Comprehensive Primary Care (CPC), CPC+, Primary Care First models, and the Maryland Primary Care Program (MDPCP).
As the CMS Administrator Chiquita Brooks-LaSure states, “The goal of the Making Care Primary Model is to improve care for people with Medicaid and Medicare. This model is one more pathway CMS is taking to improve access to care and quality of care, especially to those in rural areas and other underserved populations. This model focuses on improving care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and partnering with community-based organizations, which will help the people we serve with better managing their health conditions and reaching their health goals.”
“Ensuring stability, resiliency, and access to primary care will only improve the health care system,” adds CMS Deputy Administrator and Center for Medicare and Medicaid Innovation Director Liz Fowler. “The Making Care Primary Model represents an unprecedented investment in our nation’s primary care network and brings us closer to our goal of reaching 100% of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care arrangements, including advanced primary care, by 2030.”
The MCP model will provide assistance to clinicians at different stages of readiness as they shift towards value-based care, aligning with CMS's objective to ensure that all traditional Medicare beneficiaries are in a care arrangement with accountability for both quality and total cost of care.
Three Care Delivery Domains
The MCP Model introduces an innovative payment system aimed at providing financial support for primary care, leading to enhanced patient outcomes and ensuring fair healthcare delivery. This model encompasses three key domains of care delivery:
- Care Management: Establishing support and services for care management and empowering patients in managing chronic conditions.
- Care Integration: Strengthening relationships with specialists, incorporating behavioral health screening and evaluation to enhance patient care and coordination.
- Community Connection: Tackling health-related social needs (HRSNs) and facilitating patient access to community resources and services.
What are the Different Tracks of the MCP Model?
By providing three progressive tracks, the MCP Model enables primary care organizations to engage in accordance with their level of preparedness and capacity. Each track has distinct objectives and payment models, offering flexibility for providers transitioning to VBC or those unfamiliar with value-based care choices.
Track 1: Building Infrastructure
The major goal of Track 1 is to lay the foundation for the implementation of enhanced primary care services. Data integration, risk assessment, workflow creation, screening and referral for health-related social needs (HRSN), and managing chronic diseases are among the objectives of this track. Track 1 payment is made using a 100% Fee-for-Service (FFS) model, which offers funding for infrastructure development and additional incentives for better results.
Track 2: Implementing Advanced Primary Care
Track 2 expands upon the foundation created by Track 1. The main goals of Track 2 are to establish alliances with specialists and social service providers, put care management services into place, and include behavioral health screenings. The payment model of Track 2 is 50% FFS and 50% future
population-based payments, including financial support for infrastructure development and incentives for improved performance.
Track 3: Optimizing Care and Partnerships
In the MCP Model, Track 3 indicates the greatest degree of advancement. It emphasizes maximizing the framework for quality improvement, advancing care integration, creating linkages between social services and specialized care, and strengthening ties to community resources. The biggest financial incentives
for better results are offered by Track 3, which uses a 100% prospective population-based payment model. Although the degree of financial assistance for infrastructure expansion is smaller than for Track 2, it highlights the significance of ongoing quality improvement and care optimization.
The Program Timeline
Making Care Primary (MCP) is a 10.5-year multi-payer model with three participation tracks that builds on prior primary care models such as Comprehensive Primary Care (CPC), CPC+, and Primary Care First (PCF), as well as the Maryland Primary Care Program (MDPCP). The application period for primary care practices in participating states will open in late summer 2023, giving participants plenty of time to get ready.
Primary care practices, including FQHCs, must be registered in Medicare and bill services for at least 125 enrollees in order to be eligible to participate in the MCP Model. They also have to have 51% of their primary care locations in participating states. Practices already participating in the Medicare Shared Savings Program (MSSP) and ACO REACH are not eligible to participate.
MCP Eligibility Requirements
To take part in the model, all MCP entities must meet the eligibility criteria set by CMS.
Entities eligible to participate in MCP must be legally formed, Medicare-enrolled entities billing health services to a minimum of 125 Medicare beneficiaries with a majority of its physical office settings in the MCP test states (CO, MA, MN, NC, NJ, NM, NY, WA).
On the other hand, entities that are not eligible for MCP participation include rural health clinics, concierge practices, current Primary Care First (PCF) practices, current ACO REACH participant providers, and grandfathered tribal FQHCs. Additionally, entities cannot simultaneously participate in the MSSP (Medicare Shared Savings Program) beyond the initial six months of MCP Primary Care advancement.
The Future of Primary Care
The CMS's plan for the future of primary care takes a big step ahead with the MCP Model. It illustrates CMS's dedication to promoting primary care and achieving health equity. The MCP Model intends to address health inequities and promote equitable care delivery by including socioeconomic risk factors into payment calculations and requiring health equity strategy plans. Every Medicare member and the majority of Medicaid recipients are expected to be enrolled in an alternative payment model (APM) by the year 2030, according to the CMS. The MCP Model, with its focus on value-based care, is in line with this larger goal and demonstrates CMS's intention to change the primary care landscape.
Navigating Value-Based Care Together
Netrin Health is a prominent population health organization that harnesses the potential of people, processes, and tools to assist your organization in crucial value-based care functions, ultimately leading to success for all stakeholders in the healthcare delivery system.
As a physician-led organization and a pioneer in value-based care, Netrin Health has firsthand experience in understanding the challenges that small independent and rural providers encounter during their transition to value-based care. We are fully equipped to support your organization in aligning with the MCP Model and driving success.
If your organization is interested in participating in this innovative primary care initiative, reach out to us today for further collaboration.