New payment models for primary care.
The Centers for Medicare and Medicaid Services Innovation Center (CMMI) recently announced two new voluntary primary care payment models: Primary Care First (PCF) and Direct Contracting. PCF is a program between your practice and CMMI (similar to CPC+). Direct Contracting is available for the Integrated Network, but is advanced beyond our current network capabilities. We want to make you aware of this value-based program in which you could participate individually, as Coordinated Care will not pursue the more advanced program at this time.
The new, five-year PCF model is designed for practices experienced with value-based payment arrangements that are ready to take on downside risk for Medicare fee-for-service patients in exchange for reduced administrative burden and performance-based payments. PCF has two payment types:
- A risk-adjusted population-based payment (per-member-per-month).
- A flat primary care visit fee.
Together, these payments make up the total primary care payment, which can be adjusted up to 50%, and a maximum downward adjustment of 10% dependent on performance.
CMMI announced two cohorts: non-CPC+ practices can apply in 2019 for a 2020 start date, and current CPC+ practices can apply in 2020 for a 2021 start date (exiting CPC+ one year early). Because PCF is expected to be an Advanced APM, non-CPC+ participants will be eligible for the 5% Advanced APM (AAPM) bonus for program years 2020–2022, and CPC+ participants who exit CPC+ and begin PCF in 2021 will be eligible for the AAPM bonus for program years 2021 and 2022. CMMI is expected to release the Request for Application this fall.