Skip to main content

4 Provider benefits under the Making Care Primary model

making care primary

The Making Care Primary model presents a unique new opportunity for practices to deliver advanced primary care over 10.5 years. As a primary care provider, you may be wondering whether you should take on the risk and how you’ll manage the program requirements, especially if you’ve never participated in a value-based care model before.

In this blog, we’ll cover four noteworthy model benefits you may not have considered. These model design elements aim to reduce historic participation barriers and provide an on-ramp for primary care practices to transition to value-based care.  

Benefit #1: New structure that encourages participation

Unlike other alternative payment models, MCP aims to reduce financial exposure and some of the upfront infrastructure challenges for primary care practices with no or limited value-based care experience.

CMS created these flexibilities to encourage more primary care clinicians to participate, especially small, independent, rural and safety net organizations. In this model, value-based care experience informs the track in which a practice will enter the program, the payment mechanisms that will be applied, and the specific care delivery initiatives that the practice will undertake.

Benefit #2: Gradual three-track transition

The MCP model includes three participation tracks. Track 1 is designed for organizations that are new to value-based care. This means they have not previously participated in performance-based Medicare initiatives like Comprehensive Primary Care Plus or the Next Generation Accountable Care Organization.

Organizations that have value-based care experience have the option to start in Track 2 or 3. Participants will spend two years in each track before progressing to the next track with an extra six-month period in the track that they enter.

The track progression gradually shifts participants from the traditional Medicare fee-for-service payment system to a model with prospective primary care payments. This slow transition allows practices with less experience to take on less risk at the start of the model.

Benefit #3: Model payment options based on track

There are six underlying payment mechanisms in the MCP model. Some are present across all tracks and others are only options in specific tracks. Inexperienced practices that start MCP under Track 1 can take advantage of an upfront infrastructure payment option. This provides start-up funds for health information technology investments, increased staffing or social determinants of health strategies.

Participants in Track 2 will be eligible to bill for e-consults. In Track 3, specialty care partners can bill for ambulatory co-management, further promoting better communication and coordination among providers managing a patient’s care.

Under all tracks, participating organizations will receive enhanced service payments to reflect the patient populations’ clinical and social risk and will have the opportunity to receive performance incentive payments. Together, these elements will help practices build their capacity to transform the care delivery system.

Benefit #4: Practice transformation

The MCP model’s ultimate goal is to make primary care more available, sustainable, patient-centered and coordinated. This is a major component of the MCP model’s care delivery approach.

In each track, practices will undertake initiatives to address care integration for behavioral health and specialty care, care management and community connection. In addition, the Capability Maturity Model Integration has interwoven model components designed to improve health equity to achieve high-quality care for all Medicare beneficiaries.

Want to participate but not sure where to start?

There is still time to put together your application before the end of November 2023. If you’re stuck determining whether you have the resources and knowledge to apply, DataGen can assist.

Our countless years of expertise with multiple APMs position us to be a great resource for you. We’ll help you understand the MCP model’s payment methodology and build a strategy around your data. This way you can monitor and address future performance.

In addition to our data expertise, we can provide you with advanced consulting services that allow you to implement and operationalize care delivery requirements.

Get more information: Next steps toward participation

Want more information? Obtain a comprehensive overview of the MCP model and its deadlines in our blog post, Making Care Primary Model: 5 crucial things to know. Then, contact us today to learn more about how we can help prepare your MCP application and assist beyond acceptance, or request a demo to see our analytic and consulting services firsthand.

Comments

Popular posts from this blog

Unlock the Potential of Value-based Payment

A common misconception in healthcare practices: Organizations can quickly reap the benefits of value-based payment transformation. To launch a successful value-based payment program , practices must implement a variety of foundational pieces. It may take time, resources and data before a practice can successfully engage in VBP. In this blog, we'll cover what goes into VBP and its potential benefits. We'll also dig deeper into practice advancement strategies and how they can help you achieve your practice goals. What goes into VBP? Many practices want to implement VBP because of its payment structure and return on investment. Yet, they might not consider how to nurture a successful VBP program in their organization. It starts with a gap analysis regarding people, processes and technologies. It’s important to celebrate what is working well and intervene where improvement can be made. Successful VBP starts with the practice team. There are many perceptions vs. realities that exist

BPCIA: 4 fast facts for a successful Model Year 7 kickoff

Participation in Model Year 7 launched on Jan. 1, 2024, with the first few months being a critical time for providers. New Bundled Payments for Care Improvement Advanced Model (BPCIA) participants got their footing, and continuing participants were able to change their clinical episode service line groups for the first time since 2020.  If you’re a provider participating in this model, read on for a BPCIA refresher and four fast facts for starting MY7 right. We’ll also cover core analytics activities to support your clinical and operational success.   4 Fast facts on BPCIA Model Year 7  1.   Focus on clinical episodes and episode volume  Before MY7 began, providers used historic baseline data provided by CMS to evaluate which CESLGs they would go at risk for, ensuring there would be sufficient episode volume. Large episode volume (100 episodes/year or more) reduces random variation and helps protect providers from financial risk associated with outlier Medicare episode spend.    During