How the Making Care Primary model advances health equity

Health equity remains one of the most pressing challenges in the healthcare industry today. The Centers for Medicare and Medicaid Services (CMS) is taking a significant step forward with the Making Care Primary (MCP) model to address these disparities. 

CMS' MCP model aims to improve care quality and ensure that everyone, regardless of their background, has access to essential health services. Using CMS' goals and perspective, we will explore how the MCP model promotes health equity, its crucial components and its implications for healthcare professionals. 

Understanding the Making Care Primary Model 

CMS is leveraging the MCP model to transform the delivery of primary care services, using insights from previous models like Primary Care First (PCF). It focuses on supporting healthcare providers in delivering advanced care that meets patients' diverse needs, aiming to create a more equitable healthcare system. 

The MCP model is about improving patient outcomes and empowering healthcare providers. CMS recognizes that achieving health equity requires a multifaceted approach involving various stakeholders. From strategic planning to demographic data collection, the MCP model aims to ensure comprehensive care delivery. 

1. Strategic planning for health equity 

Strategic planning is a vital component of the MCP model. MCP participants are encouraged to develop detailed plans to identify and reduce disparities within their patient populations. This involves understanding the unique challenges different communities face and tailoring interventions accordingly. 

Healthcare professionals can leverage strategic planning to pinpoint areas where disparities are most pronounced. By doing so, they can allocate resources more effectively and implement targeted interventions that meet the specific needs of underserved populations. This proactive approach is crucial in implementing advanced primary care that bridges the healthcare gap. 

With strategic planning, the MCP model empowers healthcare providers to take a data-driven approach to health equity. It encourages continuous evaluation and adaptation of strategies based on patient outcomes and emerging trends. This flexibility ensures that healthcare interventions remain relevant and effective. 

2. Health-related social needs (HRSNs) screening and referrals 

Addressing HRSNs is another critical aspect of the MCP model. Participants must implement HRSN screening and referrals to connect patients with social services. Because social determinants of health (SDOH) influence health outcomes, HRSN screening and referral help practitioners identify and address social needs, such as housing instability and food insecurity. 

In more detail, HRSN screening is a powerful tool for identifying patients who may require additional support beyond traditional medical care. By recognizing factors such as housing instability, food insecurity and transportation barriers, healthcare providers can offer more comprehensive care solutions. 

Referrals to social services are an integral part of the MCP model's approach to health equity. By collaborating with community organizations and social service providers, healthcare professionals can ensure that patients receive the support they need to improve their overall well-being. 

3. Social risk adjustment for equitable care 

Social risk adjustment is a crucial mechanism within the MCP model that ensures equitable care delivery. First, it aligns financial incentives with the needs of specific populations, ensuring that the participants who serve more high-needs patients receive more resources. 

Enhanced service payments to healthcare providers in the MCP model support enhanced care management and are adjusted based on social risk and clinical indicators, incentivizing the provision of care to high-risk populations. This adjustment acknowledges that some patient groups face greater challenges due to SDOHs. 

4. Demographic data collection for informed decision-making 

Collecting demographic data is foundational to the MCP model. CMS gathers information on demographic characteristics and HRSNs to evaluate the MCP model’s impacts on health disparities. 

Demographic data collection enables healthcare providers to gain insights into the unique challenges different communities face. By understanding the diversity within their patient populations, providers can implement targeted strategies that address specific health disparities. 

This data-driven approach is essential for informed decision-making. It empowers healthcare professionals to design strategies and deploy interventions that can have a meaningful impact on health equity. 

5. Behavioral health performance improvement bonuses 

The MCP model recognizes the significance of behavioral health as an integral component of overall well-being. Providers can receive performance incentive payments based on utilization and quality measures, including depression screening and remission rates, incentivizing a focus on mental health. 

Depression screening is a critical step in identifying individuals who may require behavioral health support. By detecting mental health conditions early, healthcare providers can intervene promptly and provide appropriate care. 

The inclusion of behavioral health as part of the quality measurement strategy for performance incentive payments in MCP helps motivate healthcare professionals to prioritize mental health within their practice. This focus on behavioral health is essential for achieving comprehensive health equity and ensuring that all aspects of a patient's well-being are addressed. 

6. Financial risk management for small practices 

One key challenge for small practices is managing financial risk. The MCP model offers a supportive framework that allows small practices to focus on patient care without undue financial pressure. 

The MCP model does this by allowing smaller practices to take on financial risk incrementally, ensuring they can participate in the model without compromising their financial stability. By providing a gradual path to prospective primary care payments, the MCP model empowers smaller practices to engage in advanced primary care delivery. This participation is essential for expanding access to quality care in underserved communities, ultimately promoting health equity. 

7. Additional funding for care coordination and integration 

Care coordination and integration are central to the MCP model's approach to health equity. Care coordination involves seamless collaboration between primary care organizations, clinicians, specialists, social service providers and behavioral health clinicians. This integrated approach ensures that patients receive holistic care that considers all aspects of their health. 

Practices and their specialty care partner physicians can receive additional funding to support these efforts in later tracks, enabling them to deliver comprehensive care that addresses the diverse needs of their patient populations. This investment is crucial to achieving the MCP model's goal of improving care for beneficiaries and promoting health equity. 

8. Strengthening coordination between healthcare providers 

The MCP model emphasizes the importance of strengthening coordination between healthcare providers. The model aims to deliver advanced primary care services by fostering collaboration among primary care clinicians, specialists and social service providers. 

Coordination between healthcare providers is essential for ensuring that patients receive consistent and comprehensive care. It minimizes fragmentation and duplication of services, leading to improved patient outcomes and enhanced health equity. 

The MCP model encourages healthcare providers to adopt innovative approaches to coordination, such as telehealth systems for video visits, electronic consultations and certified electronic health record technology. These tools facilitate seamless communication and information sharing, further promoting integrated care delivery. CMS’ commitment to health equity 

According to CMS, the MCP model represents a significant step in promoting health equity. By addressing SDOHs, incentivizing equitable care delivery and fostering collaboration among healthcare providers, the MCP model paves the way for a more inclusive healthcare system. 

Unlock value-based care’s full potential 

Achieving health equity requires collective action and a commitment to addressing systemic disparities. DataGen's Making Care Primary solution provides customized reporting and a consulting toolkit to get the most out of MCP and its financial incentives. Contact us today to improve your quality measures and take advantage of MCP’s payment structure.