What to know before MCP model participation decisions

CMS will select participants for the Making Care Primary model soon. Once accepted, primary care practices will have to decide whether they’ll join the MCP model. This is no easy decision.

In this blog, we’ll cover what primary care practices should consider before joining MCP, focusing on readiness and model design. Learn what you need to know before officially joining MCP and beginning the onboarding process, from April to July 1, 2024.

MCP model track eligibility

When organizations applied to MCP in November, they selected from three tracks depending on their value-based care experience. Track 1 was designed for practices with little to no VBC experience. This was done to encourage small and rural practices to participate. However, participants starting in Track 1 will eventually move to Tracks 2 and 3 over the performance model years.

When CMS accepts practices, providers may be found ineligible for the track for which they applied. In these cases, they may be eligible for, and CMS may offer the organization entry into, another track. CMS will likely communicate this once it announces eligible participants.

Note: organizations that wanted to be considered for Track 1 and the up-front infrastructure payment must have originally applied to Track 1 in November 2023. CMS will not retroactively offer applicants entry into Track 1 that did not apply to that track.

MCP model readiness

Primary care practices should consider three things when assessing their readiness. After acceptance into the model, they'll need to:

• accept the MCP payment reforms;
• meet health information technology requirements listed by the date specified for each requirement; and
• meet the care delivery requirements of the track they're considering by the end of 2025.

These don't necessarily have to be done in this order. However, these are important steps that you'll need to complete to join and stay in the model. We'll break these down further in the next section.

MCP applications are not legally binding contracts; selected applicants will be required to sign a participation agreement with CMS. The participation agreement will contain detail regarding model requirements. Some aspects of the model may be modified, as CMS continues to consider stakeholder feedback and operational issues.

Before signing the participation agreement, CMS will provide each applicant information that may support financial modeling, based on the applicant’s attributed population at the time of application.

MCP payment reforms

The MCP model design’s biggest selling point is its payment structure. Developed with primary care practices with limited VBC experience in mind, the MCP model offers a progressive pathway to allow practices to gradually move through the payment changes over the model's 10.5-year span.

For now, it's important to know that the tracks gradually transition participants from the traditional fee-for-service payment system to a model with full capitation for specific primary care services, increasing the link between care delivery and payment advancement over time.

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.

Health IT requirements

According to CMS' Making Care Primary (MCP) Model Frequently Asked Questions, "MCP Health IT requirements will be designed to meet model-specific standards to promote data and health information exchange (HIE), provide patients access to electronic health information and avoid information blocking." You can learn more about this in CMS’s Health IT requirements in their Making Care Primary Request for Applications document.

With these health IT systems in place, CMS thinks participants will benefit from data sharing between clinicians, suppliers and patients. CMS also believes it will support improved care coordination with specialists through the use of e-consults. 

In Track 1, participants will start to lay the framework for these technology models, and start to adapt their current internal processes to get ready for implementation in Track 2.

Care delivery requirements

The MCP framework focuses on whole person care, striving to enhance practices primary care offerings and overall quality of care. Across its three distinct phases, these practices are presented with tailored chances to strengthen their operational base, introduce innovative tactics and refine both care processes and collaborative efforts.

Those enrolled in the model can tap into specialized educational sessions and conferences tailored to foster best practices in exchanging and promoting widespread knowledge sharing. Here’s how the specific practice transformation standards must be met within each phase:

1. Examination and preparation of infrastructure: In Track 1, the goal is to develop the foundation for implementing advanced primary care services. This stage will help the enrolled practice to build workflows, identify gaps, act on opportunities and assess their progress as they move forward.
2. Implementing advanced primary care: In Track 2, practices build on what you’ve done in Track 1 through provider partnerships, implementation of care management and behavioral health screening. Practices put into this track to start will focus on getting ready for the last track of the model. Specifically, you'll build communication with social support, optimize technology and more.
3. Optimizing care and partnerships: In Track 3, practices will take everything they've done up a notch by strengthening patient care and care integration. They'll also implement quality improvement activities, assess their impact on patient care and track their progress throughout the model.
   

Don't join the MCP model alone

The decision to adopt a CMS model is one that demands careful consideration and commitment. The MCP model is particularly well suited for those embarking on their journey into VBC, ensuring that they are not alone as they navigate these new waters.

By prioritizing patient care and outcomes, and with DataGen's specialized services — Making Care Primary and Value-based Care Consulting — providers can confidently participate in MCP, supported by expert guidance. If you have questions, don't hesitate to contact us today.