Primary Care First Applications announced: What do independent physicians need to know?

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

Last week, the Centers for Medicare and Medicaid Services (CMS) announced the release of a Request for Applications (RFA) to introduce Primary Care First, a new alternative payment model available to independent physicians that offers an innovative payment structure to support the delivery of advanced primary care.

The Primary Care First program revolves around a set of voluntary five-year payment options that reward value and high-quality care. Primary Care First is based on the underlying principles of the existing Comprehensive Primary Care Plus (CPC+) model design: prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes.

Primary Care First 101 

• Geared towards smaller practices who provide primary care services, and centered around comprehensive care management and coordination for Medicare patients and those that are seriously ill and high risk.
• Need a minimum of 125 Medicare beneficiaries to qualify for participation. Providers are incentivized for keeping patients out of hospitals (i.e. measured performance against hospital utilization).
• Due to 50% upside, doctors who earn $200,000 today could earn up to $300,000, depending on their ability to keep patients healthier.
• Must be using a 2015 CEHRT platform with API data exchange capabilities and a connection to their regional Health Information Exchange (HIE), to facilitate care coordination, which Elation can support.

Key Considerations

• The deadline to apply is January 22, 2020. Practices interested in applying have about 13 weeks (or 3 months) to prepare – so there is still time to act. Elation can help you review application details before this deadline. You can access the application here. 
• If your practice is not already participating in CPC+ and you are ready to try an advanced primary care model, Elation strongly advises you apply. Practices still have the opportunity to decide whether or not to participate after the application process. For practices considering Primary Care First, there are no downsides to applying beyond the time spent on your application. Elation is here to cut down on that time and make the process as easy as possible. The upsides in revenue for independent physicians can be significant as independent practices are already set up to provide patient-focused care.
• Practices currently participating in CPC+ will not be eligible to apply to the first cohort of Primary Care First beginning in 2021. These practices can participate in the second cohort starting in 2022. The applications for that cohort will be released in Spring 2021. These practices are encouraged to apply as they will be prepared coming from CPC+. Learn more about eligibility here. 

Upcoming Primary Care First Webinars

CMS is planning a series of webinars to help interested practices learn more about Primary Care First and the application process. There will be an Application Webinar on October 30th and the Seriously Ill Population (SIP) Part II Webinar on October 31st.

Elation is also available as a resource for physicians who are interested in participating in this program and succeeding. Contact us today to get started. 

Related Links: 

• Primary Care First Explained: Everything independent physicians need to know about Medicare’s new quality program for primary care
• What are the benefits of participating in Primary Care First as an independent practice?
• Who is eligible to participate in Primary Care First?
• What kinds of organizations could get the most out of primary care first?
• How will technology play a role in Primary Care First?