Washington will be one of eight states that will test a new primary care model aiming to improve capacity, downstream costs, and behavioral health services.
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The Centers for Medicare and Medicaid Services’ (CMS) recently issued a request for applications for its new Making Care Primary (MCP) Model. The MCP model will be launched on July 1st, 2024, and will be tested in Washington, Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, and Massachusetts.
The 10.5-year model aims to improve care management and coordination, equip primary care clinicians with tools to form partnerships with healthcare specialists, and leverage community-based connections to address patients’ health needs as well as their health-related social needs like housing and nutrition.
Washington State Health Care Authority (HCA) Chief Medical Officer Dr. Judy Zerzan-Thul hosted a webinar for providers on Thursday to discuss the benefits of the new model. She said MCP could help support the state’s overwhelmed behavioral health system.
“Primary care has the potential to reduce downstream costs. Primary care is not prepared to support our overwhelmed behavioral health system in Washington. We want to continue to invest in primary care that can provide prevention, early intervention, and post-stabilization management for people with behavioral health needs.”
The state has taken steps to address primary care concerns. The Washington Health Care Cost Transparency Board is working on defining a primary care expenditure target, and the state created the Primary Care Transformation Model (PCTM) to standardize expectations for primary care delivery and collaborate on supports and payment policies to support providers. MCP seeks to bring Medicare collaboration and payment into multi-payer primary care efforts like the PCTM.
“This federal CMS innovation seeks to bring Medicare into that model and I think that will make our efforts more successful,” Zerzan-Thul said.
MCP will bring Medicare fee-for-service funding and additional alignment to Washington’s primary care efforts. It aims to create a pathway for more practices to enter value-based care arrangements, address health-related social needs, progress to prospective payment, and reward quality outcomes.
“It allows practices to evolve. It is a cost-neutral model, so the idea is to invest what savings there are back into primary care. There are care teams at the center of this that include behavioral health integration. There will be data sharing; there’s a connection to health information exchange that can help do that. There’s no downside risk in this model, so practices can focus on improving health for their patients.”
Practices that provide primary care services to patients may be eligible to apply for MCP, including independent primary care practices, group practices, federally qualified health centers, health systems, Native health programs, certain critical access hospitals, organizations operating in other MCP states, and organizations with at least 125 attributed Medicare fee-for-service beneficiaries.
MCP includes three tracks that healthcare organizations can select from when applying to the model. An organization’s past experience with value-based care will determine their eligibility for tracks. The tracks provide opportunities for organizations with differing levels of care delivery and value-based payment experience to enter the model at a point that matches their capabilities.
“Track two is where practices start to transform and move to a fee-for-service model,” Zerzan-Thul said. “Of note in the first two tracks, practices can be in those stages for 2.5 years before moving on to the next one.”
Prospective primary care payment increases over time, while fee-for-service decreases. Enhanced service payments decrease over time as practices become more advanced, and the potential for payments tied to quality performance increases. Performance incentive payment potential greatly increases over time to make up for decreases in guaranteed payments.
“By track three, the bulk of your reimbursement will be on a prospective payment basis,” Zerzan-Thul said. “That really puts a lot of (potential) for practices to improve and be rewarded for that.”
Interested providers will need to submit their application by Nov. 30th. Eleanor Escafi, director of network innovation at Regence, voiced her support for MCP, noting its commitment to providing whole-person care over extended time periods.
“That is the key difference between primary care and the rest of the care continuum. Regence encourages practices to sign up by the Nov. 30th deadline. I see MCP as advancing practices with supports in place. We are excited to see the momentum that will be built.”
Dr. Angela Sparks, chief medical officer at UnitedHealthcare Washington, also voiced her support for MCP, highlighting its potential for collaboration.
“What’s really going to make this sing is the continued collaboration between HCA, clinicians in the state, and payers to be able to move this forward together,” Sparks said. “We support the objectives of MCP, and how it will work with the state Medicare program to improve health equity and reduce costs. I don’t see a downside risk, just lots of upside at this time.”