Primary Care First update

The initial cohort of the Primary Care First model went live on Jan. 1.  Cohort 1, represented by 822 practices and 14 payer partners, is offered in 26 regions across the country. Over the six-year PCF demonstration period, CMS will test whether advanced primary care practices can improve patient experience and quality, reduce total cost of care and manage risk through performance-based payments, while decreasing the administrative burdens and increasing financial incentives for a primary care practice. PCF puts particular focus on comprehensive care coordination and the doctor-patient relationship.

The Center for Medicare and Medicaid Innovation announced several PCF model updates in the last few weeks:

1. The Seriously Ill Patient component of PCF, which would have gone live on April 1, has been postponed until further notice and is currently under review. The SIP component was established for practices that could focus on patients with complex chronic needs and fragmented care patterns. Practices caring for these patients or willing to accept this patient population would receive higher payments under the PCF model.
2. The applicants for the second PCF cohort will go at risk for a five-year period in the PCF model beginning Jan. 1, 2022.
3. In the initial program announcements, Cohort 1 excluded practices that participated in the Comprehensive Primary Care Plus model, and Cohort 2 was only open to CPC+ practices. Cohort 2 will now be open to all primary care practices that meet eligibility criteria. CMS acknowledges the need to establish, preserve and reinforce the role of primary care in light of the COVID-19 public health emergency.
4. The model will continue to be offered in 26 regions – this includes the 18 CPC+ regions plus eight additional regions that were added specifically for PCF. To date, Cohort 1 practice participants are represented in 22 of the eligible regions and Cohort 1 payer partners are represented in 24 of the eligible regions.

DataGen hosted a webinar to help participants prepare for the new model and build the right foundation for success. Listen to this webinar recording to learn:

• what you need to know about the PCF Model;
• important details on the upcoming application deadline; and
• strategies to prepare for the at risk period.