Summary
On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) announced the Primary Cares Initiative (PCI), a suite of five voluntary payment models aimed at overhauling primary care. Marking the Trump Administration’s latest investment in Medicare value-based reform, PCI focuses on the role of primary care providers as the central coordinators of patient health, with the goal of enhancing patient care while lowering overall Medicare fee-for-service (FFS) costs. Once implemented, CMS estimates that more than a quarter of all Medicare FFS beneficiaries – nearly 11 million individuals – will be included in these transformative primary care delivery models.
If the PCI approach sounds familiar, it’s because these models share ancestral ties with the CMS Innovation Center’s ongoing primary care redesign effort, Comprehensive Primary Care Plus (CPC+). Currently operating in 18 regions, CPC+ offers primary care practices financial incentives in addition to standard FFS payments to redesign their approaches to care delivery. However, while initial results for the CPC+ model show promise, the Administration is looking for more aggressive and large-scale change.
Enter PCI. As designed, these models take risk-bearing farther than before, focusing on improved beneficiary health outcomes, while leveraging public- and private-sector approaches to foster innovation. Each of the five PCI models offer tools for providers to develop advanced primary care delivery approaches in exchange for greater accountability, or risk-sharing.