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What kinds of organizations could get the most out of primary care first?

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

Click here to read our overview of Primary Care First.

Primary Care First Factsheet

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The recently announced Primary Care First initiative is designed to incentivize high quality healthcare and lower hospitalization rates. The Centers for Medicare & Medicaid Services (CMS) Innovation Center developed Primary Care First primarily to improve care outcomes and to reduce healthcare costs, particularly the costs of hospitalizations, as concerns grow over Medicare’s Part A funding that is projected to be depleted by 2026. Primary Care First is a voluntary program designed to encourage providers to share in the risks and to reap the rewards of value-based healthcare.

Primary care providers who are focused on preventative care as well as those who care for complex, chronically ill patients will see the most benefit from participating in the Primary Care First initiatives. In addition, there is a second payment model designed for primary care physicians who “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.”

Another consideration for organizations considering the voluntary program, as pointed out by the Editor Emeritus of Modern Healthcare, Merrill Goozner, in an editorial is that the “organizations that do best in these programs invest heavily in care coordination.” This includes primary care practices that “focus on preventing hospitalizations among the 5% of patients with multiple chronic conditions who generate half of all spending.”

Organizations that could get the most out of the Primary Care First initiative address medical needs with a wellness mindsight. In Goozner’s words, these organizations “address unmet medical needs like untreated hypertension, pre-diabetes and behavioral health. They deploy social workers and home health aides to help patients address their nonmedical social needs like poor nutrition and inadequate housing.”

Overall, ideal Primary Care First participants are those who are willing to share the risk to potentially earn financial rewards. As CMS describes it, “the general Primary Care First payment model option is designed for primary care practices with advanced primary care capabilities that are prepared to accept increased financial risk in exchange for flexibility and potential rewards based on practice performance.”

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