A New Road to Value-Based Payments for Primary Care Providers

The Primary Cares Initiative (PCI) announced in April 2019 demonstrates that CMS remains committed to its patient-centric approach to care delivery, particularly with respect to primary care providers, who are on the front line of patient care. PCI’s new value-based payment arrangements complement an overarching strategy to transform primary care and recognize that strengthening primary care correlates with a higher quality of care, better patient outcomes, and lower costs.

There are two new, innovative PCI payment arrangements for primary care physicians (PCPs) to choose between: Primary Care First (PCF) and Direct Contracting (DC). The goal of both is to enhance patient access and lower the total cost of care while reducing administrative burden. PCPs who are interested and willing to participate in the PCF value-based payment arrangements are expected to apply by January 22, 2020.

PCPs choosing to participate in the new PCI arrangements are expected to realize several benefits, such as:

PCI Framework

The PCI offers PCP practices five model options, based on the practice’s experience in managing risk, in order to strive for enhanced patient care using low-cost treatment options and continuum-of-care protocols.

The PCF models have a five-year term and are currently accepting applications, with a model launch set for January 2021. A second application window in 2021 will focus on practices currently participating in CPC+ payment arrangements that want to transition to PCF beginning in January 2022. Separately, the DC models are intended for organizations that have experience with financial risk, such as CPC+ and Medicare Advantage (MA) payment arrangements. Together, the PCF and DC payment arrangements are predicted to offer 25% of Medicare fee-for-service (FFS) beneficiaries (approximately 11 million), as well as a significant number of dually eligible beneficiaries, an option to voluntarily participate in order to realize better access to coordinated care between their PCP and other healthcare providers.¹