HHS Announces New Value-Based Payment Initiative

The US Department of Health & Human Services (HHS) recently announced a new series of five value-based payment models being offered as the centerpiece of a five-year, value-based payment pilot. The pilot aims to ‘transform primary care to deliver better value for patients throughout the healthcare system.’

Formally known as the Primary Cares Initiative, the program will feature five new payment models for serving Medicare beneficiaries. Two broad pathways are being offered: Primary Care First (for individual practice sites) and Direct Contracting (for population management organizations like ACOs, MCOs, CINs, etc.) Both pathways will provide performance-based payment adjustments to physicians who reduce hospital utilization and total cost of care, with each pathway designed to test whether financial risk and performance-based payments to primary care physicians and other clinicians will reduce total Medicare expenditures, maintain quality, and improve results. Each pathway will focus on individual primary care practice sites and will be tested for five years beginning in January 2020; a second round of applications is scheduled for participants starting in January 2021. The Direct Contracting pathway is available nationwide. Unfortunately, the Primary Care First program is only offered in limited areas and is not yet available in North Carolina.

The AAFP is analyzing the details of the initiative and will be offering an executive summary to help guide family physicians looking to participate. A high-level overview was recently published in AAFP’s In the Trenches. Look for additional information in the weeks ahead. . In addition, CMS is holding a series of webinars for practices interested in learning more about participating in the CMS Primary Cares Initiative in the Direct Care Model options. See this page for additional details.Image courtesy of AAFP