Empowering Primary Care: Perspectives on New Models and Partnerships

Question 1:

The CMS Making Care Primary Model (MCP)that was announced last year promotes health equity, establishes a transformation glidepath to scale successes into the MSSP, and seeks to achieve multi-payer alignment. This model, kicking off in July in eight states, is focused on supporting less experienced primary care practices with limited experience in alternative payment models (APM), helping them build advanced care delivery capabilities, foster coordination with specialty partners and, over time, assume prospective payments and accountability for cost and quality outcomes. What does this new APM offer to less experienced primary care practices that are interested in pursuing a strategy in value-based care?

Answer: In many ways like predecessor CMMI advanced primary care models, MCP provides practices technical assistance and financial support to advance their care teams, IT systems and other care delivery capabilities necessary to improve the quality of care and health outcomes of their patients through coordinated interdisciplinary care teams. Practices starting in Track 1 of 3 under MCP focus on building infrastructure for advanced primary care, including risk stratification and chronic disease management. They receive fee-for-service payments with additional financial support to develop their care capabilities. As practices progress to Track 2, they implement advanced care coordination with a blend of fee-for-service and prospective payments. Finally, in Track 3, practices fully transition to prospective, population-based payments, assuming greater accountability for cost and quality outcomes.

The MCP Model’s emphasis on health equity is particularly significant for primary care practices serving diverse populations. By promoting multi-payer alignment, the model ensures that these practices can benefit from consistent incentives and support across different payers, which can streamline their operations and enhance their financial stability. Furthermore, the transformation glidepath provided by the MCP Model enables practices to scale their successes and integrate them into larger value-based care frameworks, such as the MSSP. This scalability is crucial for sustaining long-term improvements in care delivery and patient outcomes. Overall, the MCP Model offers a structured and supportive pathway for less experienced primary care practices to transition to value-based care, fostering better care coordination, financial sustainability, and health equity.

Question 2:

The CMS Innovation Center also recently announced this month the launch of the new ACO Primary Care Flex Model (ACO PC Flex) that is aimed to improve access to high-quality primary care for underserved Medicare populations.  ACO PC Flex will provide a one-time advanced shared savings payment and monthly prospective primary care payments to ACOs. These advanced shared savings payments will provide the access to capital needed for covering the costs associated with running an ACO. What potential impact might the new ACO Primary Care Flex Model have in addressing the financial challenges faced by ACOs and primary care practices, especially those caring for underserved populations?

Answer: It’s well established that experienced, physician led ACOs achieve higher quality outcomes and more financial cost savings under the MSSP. Developing and operating an ACO is complex and requires significant upfront and annual investment. Consider that many MSSP ACOs do not earn a shared savings payment from CMS in their initial performance years, and the 6-8 month lag to receive a shared savings payment if they do creates a significant cash flow issue, and it’s no wonder why ACOs and practices are hesitant to participate or gradually assume downside risk, especially those situated in underserved communities.

I think CMS looked at the data and recognized this dynamic needed to be addressed in order to grow the MSSP program and to be in a better position of achieving the 2030 goal of 100% of Original Medicare beneficiaries receiving their care from an accountable care organization. The PC Flex Model should encourage more ACO participation by targeting the financial barriers that hinder ACOs and practices by ensuring a stable revenue stream by offering the one-time advanced shared savings payment and monthly prospective primary care payments. These payments help ACOs cover operational costs, invest in care management infrastructure, and implement quality improvement initiatives. The financial support from PC Flex addresses the upfront costs of transitioning to value-based care, enabling practices to hire care coordinators, implement health IT systems, and develop patient engagement programs to improve care delivery and patient outcomes for vulnerable communities.

Question 3:

Lumeris provides flexible partnership options to mitigate provider risk and ensure that all value-based populations are represented by the best-fit CMS Program and payer relationship. How does Lumeris support its health system and practice partners with choosing the payment model that is best for them?

Answer: We at Lumeris meet our partners where they are at today in their value-based care journey and provide a comprehensive suite of risk-based Medicare offerings to ensure the Medicare patients our partners serve are placed into the best collaborative CMS Program or Payer relationship that encourages high-quality delivery of care and rewards providers for the efficient delivery of care through incentives and value-share. Jointly, we accomplish this through a personalized, strategic approach using advanced analytics to assess patient populations, network composition, operational strengths and financial performance, developing tailored roadmaps that align with our partner’s goals. Ultimately, we try to develop a truly aligned partnership that accelerates value-based care adoption through financial risk-sharing and hands-on support for implementing new care delivery models, including staff training, workflow optimization, and patient engagement strategies.