Saturday, February 15, 2020

Primary Care First Model

Is your organization participating?
Primary Care First Model Options is a set of voluntary five-year payment options that reward value and quality by offering an innovative payment structure to support delivery of advanced primary care. Primary Care First is based on the underlying principles of the existing CPC+ model design: prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes. 

Primary Care First Model Options will be offered in 26 regions for a 2021 start date: Alaska (statewide), Arkansas (statewide), California (statewide), Colorado (statewide), Delaware (statewide), Florida (statewide), Greater Buffalo region (New York), Greater Kansas City region (Kansas and Missouri), Greater Philadelphia region (Pennsylvania), Hawaii (statewide), Louisiana (statewide), Maine (statewide), Massachusetts (statewide), Michigan (statewide), Montana (statewide), Nebraska (statewide), New Hampshire (statewide), New Jersey (statewide), North Dakota (statewide), North Hudson-Capital region (New York), Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky), Oklahoma (statewide), Oregon (statewide), Rhode Island (statewide), Tennessee (statewide), and Virginia (statewide).

The PCF model includes professional population-based payments and flat primary care visit fees to help practices improve access to care and transition from FFS to population-based payments. 

If your practice is located in one of the 26 regions and has at least 800 FFS Medicare patients, you should strongly consider particpating in the PCF model.  

  • Primary Care First practices may also participate in ACOs in the Medicare Shared Savings Program (Shared Savings Program).
  • Primary Care First practices may not participate in the Next Generation ACO Model or the Comprehensive End Stage Renal Disease (ESRD) Care Model. 

If you have any questions or need additional guidance navigating the Primary Care First Model, ERM Consulting can help!

Todd Gifford, MBA, CRC 

Kameron Gifford, CPC