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CMS extends application deadline for new Making Care Primary program

News
Article

Value-based care to launch in eight states in July next year.

© U.S. Centers for Medicare & Medicaid Services

The U.S. Centers for Medicare & Medicaid Services published this illustrated overview of the new Making Care Primary value-based care payment model as part of the request for applications for the program. It will be in July 2024 and run 10.5 years.
© U.S. Centers for Medicare & Medicaid Services

Federal officials have extended the application period for Making Care Primary (MCP), a new value-based care program that will develop in eight states over the next decade.

The U.S. Centers for Medicare & Medicaid Services (CMS) announced the deadline is extended two weeks to Dec. 14.

Making Care Primary will run July 2024 to December 2034 as a multi-payer model that builds on lessons learned in the CMS Innovation Center’s prior advanced primary care models. It will begin in Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts, and Washington.

“The MCP Model will provide a pathway for primary care clinicians with varying levels of experience in value-based care to gradually adopt prospective, population-based payments while building infrastructure to improve behavioral health and specialty integration and drive equitable access to care,” the CMS model overview said. “State Medicaid agencies will commit to designing Medicaid programs to align with MCP in key areas.

“This model will attempt to strengthen coordination between patients’ primary care clinicians, specialists, social service providers, and behavioral health clinicians, ultimately leading to chronic disease prevention, fewer emergency room visits, and better health outcomes,” the overview said.

CMS’s published request for applications said the program has three goals:

1. Ensure beneficiaries in participating organizations receive primary care that is integrated, coordinated, person-centered, and accountable.

2. Create a pathway for primary care clinicians, especially small and independent, rural, and organizations supporting underserved communities, to adopt prospective, population-based payment to become more accountable for cost and quality of care for their population of patients.

3. Improve the quality of care and health outcomes while reducing or maintaining program expenditures.

The MCP application is nonbinding and should take no more than 15 minutes to complete, according to CMS. To qualify, applicants must:

  • Be a legal entity formed under applicable state, federal, or Tribal law authorized to conduct business in each state in which it operates.
  • Be Medicare-enrolled.
  • Bill for health services furnished to a minimum of 125 attributed Medicare beneficiaries.
  • Have the majority (at least 51%) of their primary care sites (physical locations where care is delivered) located in an MCP state.

MCP will have three tracks for participating organizations, including one reserved for organizations with no experience in value-based care.

CMS has published a sample revenue sheet comparing MCP with Medicare fee-for-service (FFS) payment. Participating organizations may be eligible for performance incentive payments for helping patients control conditions such as diabetes and high blood pressure, and screening for colorectal cancer, social drivers of health, and depression.

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