Primary Care First
Primary Care First Model Options
Primary Care First was a voluntary alternative five-year payment model that rewarded value and quality by offering an innovative payment structure to support the delivery of advanced primary care. It prioritized the clinician-patient relationship, enhanced care for patients with complex chronic needs, and focused financial incentives on improved health outcomes.
Innovation
Offered a simple payment structure including a flat payment for in-person treatment, a population-based payment for flexibility, and a performance-based adjustment providing an upside of up to 50% and a small downside of negative 10%.
The Problem
Patients who do not regularly see a primary care doctor are significantly less likely to get regular health screenings, monitoring for emerging health issues, and other preventive health care. These patients may see their health issues worsen, causing them to seek higher cost care, such as hospitalization, trips to the emergency room, or greater need to use specialty care.
The Solution
The model was designed to help primary care practices better support their patients in managing their health, especially those with complex, chronic conditions. It enabled primary care doctors to offer a broader range of health care services, such as around-the-clock access to a clinician and support for health-related social needs.
Expected Outcomes
Improved quality of patient care, reduced avoidable hospitalizations, reduced total cost of care, and improved patient experience of care.
Strategy
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.
Model Goals
- Improve quality
- Improve patient experience of care
- Reduce expenditures
- Increase patient access to advanced primary care services
Patient Eligibility
Medicare beneficiaries attributed to Primary Care First practices.
- Minimum of 125 attributed Medicare beneficiaries at a particular location.
Provider Eligibility
Primary care practices located in one of the 26 eligible regions with specific practitioner certifications, revenue requirements, and health IT capabilities.
- Located in one of the 26 Primary Care First regions.
- Included primary care practitioners (MD, DO, CNS, NP, and PA) certified in internal medicine, general medicine, geriatric medicine, family medicine, and hospice and palliative medicine.
- Provided primary care health services to a minimum of 125 attributed Medicare beneficiaries at a particular location.
- Primary care services account for at least 50% of the practice’s collective billing based on revenue.
- Had experience with value-based payment arrangements or payments based on cost, quality, and/or utilization performance.
- Adopted and maintained health IT meeting the definition of CEHRT and supported data exchange via API and connected to regional HIE.
- Attested to advanced primary care delivery capabilities, such as 24/7 access to a practitioner or nurse call line and empanelment of patients.
Care Categories
Primary Care
CMS Benchmarks & Thresholds
eligibility
financial
operational
population
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