CMS announces new initiative in Advanced Primary Care

Advanced Primary Care Initiatives

The Centers for Medicare & Medicaid Services (CMS) is seeking input on initiatives to test innovations in advanced primary care, particularly mechanisms to encourage more comprehensiveness in primary care delivery; to improve the care of complex patients; to facilitate robust connections to the medical neighborhood and community-based services; and to move reimbursement from encounter-based towards value-driven, population-based care.

Background

Advanced primary care is based on principles of the Patient Centered Medical Home and builds on the care delivery models employed in other CMS model tests, including the Comprehensive Primary Care Initiative. Next generation model(s) for advanced primary care would seek to improve further the delivery of patient-centered care and population health. General topics of interest include:

• increased comprehensiveness of, and patient continuity with, primary care (i.e., care provided with greater depth and breadth and through longitudinal relationships between patients and primary care providers),
• care of patients with complex needs, 
• closer connections between primary care and other clinical care (“the medical neighborhood”) and community-based services, 
• moving from encounter-based payment or encounter-based payment with care management fees towards population-based payments (PBPs) to support the infrastructure needed for advanced primary care, create incentives for innovation in care delivery, and promote accountability for costs and quality of care, including consideration of appropriate mechanisms to assign beneficiaries to unique practices, 
• mechanisms to support small primary care practices in the transformation to advanced primary care,
• advanced primary care within accountable care organizations (ACOs),
• multi-payer participation,
• performance measurement that is meaningful to beneficiaries and clinicians,
• matching documentation requirements to the goals of advanced primary care while protecting MS program integrity, and
• use of health information technology (HIT), including electronic health records, data analytics, and population health tools, to support advanced primary care.

Request For Information

CMS seeks broad input from consumers and consumer organizations, health care providers, associations, purchasers and health plans, Medicaid agencies and other state offices, quality review organizations, social service providers, HIT vendors, and other stakeholders. Submissions must be supplied using the Request for Information (RFI) (PDF). To be assured consideration, comments must be received on or before 11:59pm EDT, March 16, 2015. For questions regarding RFI submission please contact APC@cms.hhs.gov.

Additional Information

• Request for Information (RFI) (PDF)