CMS has issued its first evaluation report for Primary Care First . The report offers a window into: key attributes of advanced primary care practices; strategies for lowering costs and reducing hospitalizations; and new strategies that signal practice transformation. Future PCF program evaluations will include which practice implementations worked and how they improved quality. In the meantime, even if your medical group is not a PCF participant, you can glean insight into what CMS is looking for as it evolves its Alternative Payment Models and how practices committed to value-based care are prioritizing and evolving their practice transformation strategies. First, some background on PCF. Primary Care First (PCF): Focus areas, risk models and payments PCF is designed to improve care quality and patient experience, increase access to advanced primary care services and reduce expenditures. PCF builds upon CMS’s Comprehensive Primary Care Initiative (CPC Classic) and Comprehensive Primar...

Patients' primary care visits outside of their attributed primary care office, also called “leaked” patient visits, can have unintended consequences for Primary Care First participants. Beginning July 2022, PCF Cohort 1 will face a reduction in population-based payments based on their leakage rate. The payment adjustment will be based on their 2021 claims data and will roll forward quarterly. To calculate your leakage rate, divide the number of qualifying visits and services your attributed beneficiaries have made to care centers outside of your practice (for example, visits to urgent care centers) by the total number of qualifying visits and services your attributed beneficiaries have made. Calculating primary care leakage with claims data alone comes with some unintended challenges. Unfortunately, some circumstances can unfairly and negatively impact a practice’s leakage rate: Nuances classifying care delivered by provider team members: It’s difficult to distinguish ...

Primary Care First (PCF) participants need to pay attention There is a renewed emphasis on advancing primary care. Primary care serves as the front door to the overall healthcare system, and early and accurate diagnosis can lead to fewer hospital admissions – a metric that has become especially important during the pandemic. With the January 2022 launch of Primary Care First Cohort 2, it is important to review what steps healthcare organizations should take to ensure the best outcomes. To be successful, PCF participants must pay special attention to three aspects: tracking the beneficiary population, obtaining physician buy-in, and ensuring timely access to performance metrics. 1. Tracking Beneficiary Population Tracking patients participating in the PCF program is necessary to build patient navigation processes and monitor care outcomes. However, this can be challenging for many providers as internal EMR solutions do not provide complete data across the entire continuum of care f...

CMS has introduced more than 50 innovative care delivery models designed to drive health system transformation over the last decade. Only six of those produced significant savings; of those, only four met the requirements to be expanded. As the second 10-year period of the program gets underway, which includes $10 billion in new funding, CMS’ Center for Medicare and Medicaid Innovation is considering numerous changes to improve the overall success of these programs and, in turn, drive overall gains in care outcomes and health equity. When evaluating what has worked in the past and what changes are needed moving forward, it is important to review what success looks like for Alternative Payment Model programs.  CMMI relies on three benchmarks to measure levels of success The gold standard: improving quality of care while simultaneously reducing expenditures. Improving quality of care without impacting expenditures. Reducing expenditures without impacting quality of ...