Making care primary: Medicare's latest attempt at value-based primary care

Area of Science:

• Health Policy
• Healthcare Management
• Value-Based Care

Background:

• The Centers for Medicare and Medicaid Innovation (CMMI) introduced the Making Care Primary (MCP) model on June 8th, 2023.
• MCP is a ten-year initiative designed to transition primary care towards a value-based payment system.
• It represents a multi-payer partnership with a voluntary, risk-adjusted payment structure for primary care organizations.

Purpose of the Study:

• To analyze the structure and potential implications of the Making Care Primary (MCP) model.
• To evaluate MCP's role in transforming primary care delivery and payment systems.
• To identify potential challenges and unintended consequences of the MCP initiative.

Main Methods:

• The MCP model features three tracks, offering varying levels of financial support and risk.
• It includes prospective payments per beneficiary and incentives for infrastructure development.
• Physicians must meet criteria for quality outcomes, social needs screening, and chronic care management.

Main Results:

• The MCP model provides financial support for value-based care infrastructure.
• It offers prospective payments and risk-adjusted models for primary care organizations.
• Physician participation requires adherence to quality and care management standards.

Conclusions:

• The MCP model is a significant effort to reshape primary care payment and delivery.
• Potential challenges, similar to previous CMS initiatives, may affect MCP's success.
• The model could lead to unintended consequences, including effects on market consolidation.