Tips for succeeding under Primary Care First as a small practice

November 15, 2019

Leona Rajaee

This post is part of a series of posts that aim to educate independent primary care practices about CMS’ recently announced Primary Cares Initiative.

The primary goals of the Primary Care First initiative, recently announced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center are to reduce hospitalization, reduce healthcare costs overall, and improve the quality of healthcare outcomes for patients. To this end, primary care practices that choose to participate in the Primary Care First payment model must work to ensure their patients are receiving the highest quality care and are meeting CMS guidelines as they deliver advanced primary care services to their Medicare patients.

Small practices participating in Primary Care First can succeed by prioritizing the patient-physician relationship, focusing on managing the care of their patients, coordinating that care with other providers, and engaging with their patients more fully to ensure high-quality outcomes. As CMS states, “Primary Care First fosters practitioner independence by increasing flexibility for primary care, providing participating practitioners with the freedom to innovate their care delivery approach based on their unique patient population and resources.

Care coordination between multiple providers will become a significant key to the success of a small practice participating in the Primary Care First initiative. In the general payment option, CMS is offering “new, higher payments for practices that care for complex, chronically ill patients.” Caring for these patients requires consistent and effective communication between the primary care provider and specialty providers, laboratories, and healthcare facilities caring for the patient, as well as communication between the primary care physician and the patient.

Managing population health appropriately will also be key to a small practice’s success in the Primary Care First initiative. In the High Need Populations payment option, CMS “encourages advanced primary care practices, including practices whose clinicians are enrolled in Medicare and typically provide hospice or palliative care services, to take responsibility for high need, seriously ill beneficiaries who currently lack a primary care practitioner and/or effective care coordination.”