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History of CMS primary care initiative

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Many factors went into the development of the Centers for Medicare and Medicaid Services (CMS) Primary Cares Initiative, including a concern for patient healthcare outcomes, a need to reduce healthcare costs, and a focus on reducing hospitalizations. Based on the previous Comprehensive Primary Care (CPC) models, the new initiative includes five models developed by the Center for Medicare and Medicaid Innovation (CMMI) with input from physicians and organizations such as the American Academy of Family Physicians (AAFP) and the American Medical Association (AMA).

CPC models were launched in October 2012 as a “a four-year multi-payer initiative designed to strengthen primary care.” CPC was the foundation of a five-year initiative, Comprehensive Primary Care Plus (CPC+), “a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation.” Each of these initiatives offered various levels of physician participation, based on different payment models. The original CPC initiative concluded in 2016.

CPC+ was launched in January 2017, integrating “lessons learned from CPC, including insights on practice readiness, the progression of care delivery redesign, actionable performance-based incentives, necessary health information technology, and claims data sharing with practices.” CPC+ included three payment elements: Care Management Fee (CMF); Performance-Based Incentive Payment; and Payment under the Medicare Physician Fee Schedule, with two track options.

The latest initiatives were developed by CMMI with input from stakeholders and a focus on the need to improve primary care outcomes that will reduce hospitalization rates for Medicare recipients. When announcing the CMS Primary Cares Initiative, CMS Administrator Seema Verma referenced the financial state of what is commonly known as Medicare Part A. Essentially, the Social Security Board of Trustees reported “that the Hospital Insurance (HI) Trust Fund portion—otherwise known as Medicare Part A—will be depleted in 2026, the same year projected in last year’s report. Revenues will be enough to pay 89% of HI costs.”

In regard to the CMS Primary Cares Initiative, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar stated that “For years, policymakers have talked about building an American healthcare system that focuses on primary care, pays for value, and places the patient at the center. These new models represent the biggest step ever taken toward that vision.” He added, “these models will test out paying for health and outcomes rather than procedures on a much larger scale than ever before.”