Transforming primary care: A closer look at the CMS Primary Cares Initiative

The rapid transition to a risk-based model has many healthcare providers searching for strategies to make the best of new CMS payment directives. And this year, as five new payment models have been introduced as part of the CMS Primary Cares Initiative, under an umbrella of two new tracks (Direct Contracting and Primary Care First), it’s even more critical to think ahead on how to embrace the changes.  

Clive Fields, MD, with VillageMD, a national primary care clinic developer, and Jim Daniel, JD, MBA, Hancock, Daniel & Johnson, P.C., are experts on what providers can expect as the new payment models are rolled out, as well as the specific impacts they may have on primary care. Succeeding in a largely risk-bearing payment model requires a comprehensive and committed approach — from the top down, according to Fields and Daniel.

“If a CFO or a risk-bearing entity can’t change culture inside an organization to truly be primary care, they’re going to fail,” Fields said. “I would look at it as a very challenging cultural place where people have moved away from a fee-for-service, fee-driven, procedure-oriented environment. Once you have truly embraced risk, it needs to be adopted culture-wide.”

Fields and Daniel addressed the implications of the Primary Cares Initiative during April’s MGMA20 | The Financial Conference in Nashville, Tenn., with a special emphasis on the mechanics of those new payment models. They said care needs to be taken to understand the changes to eligibility, the application process and alignment opportunities, in addition to payment adjustments and population-based payments. 

More importantly, Fields and Daniel said the move to value-based care involves a bit of soul-searching on the part of those at the top of the corporate ladder. It’s essential to understand that the long-term benefits of programs such as the Primary Cares Initiative will indeed pay off – perhaps just in a slightly different way.
 
“We still see lots of CMOs and senior hospital executives paid on a daily census, on revenues and procedures, and I’m just not sure those folks are going to work the way they should to create success in this model,” Fields said. “Ultimately, it is going to be far more successful because now you can get paid for things that you don’t do, instead of things that you do. It’s a lot less expensive not to do things. That’s always been the rub, to get the C-Suite to truly match up their own income opportunity with a risk-bearing entity instead. They’re getting paid in volume, and everyone else is supposed to work on value.”  

Fields and Daniel’s session will also address and differentiate key aspects of the Primary Care Initiatives from CMS’s other payment models, including Next Gen ACO, the Medicare Shared Savings Program and Comprehensive Primary Care Plus.

ADDITIONAL RESOURCES:

• "Taking the fear out of new codes and embracing eConsults"
• "Managing financial risk through patient risk scoring"
• "Using analytics to automate and streamline your medical practice's revenue cycle"
• "The upside of downside: Innovative strategies for protecting downside risk"
• "Navigating the unknowns of an underperforming revenue cycle"