Primary Care First: A Quick Overview

Primary Care First

There Are A few Things You Should Be Aware of About Primary Care First

Primary Care First (PCF), innovative care delivery and reimbursement paradigm designed by the CMS Innovation Center is a distinct method for improving primary care. PCF criteria and the care delivery model are similar to the Comprehensive Primary Care Plus (CPC+) framework in some ways, but they differ in others.

In 2019, the Centers for Medicare & Medicaid Services (CMS) announced a five-year alternative payment system based on voluntary participation to drive more value and quality in primary care delivery by introducing an innovative payment structure – Primary Care First (PCF). The PCF initiative is intended to provide more value to participants by boosting precision and accuracy while simultaneously lowering healthcare costs.

Primary Care First reflected the core precepts of the conventional Comprehensive Primary Care Plus (CPC+) prototype launched in 2017, focusing on improving the physician-patient association; amplifying patient care for complex chronic needs and elevated clinical care, severely sick patients, minimizing administrative overload, and targeting financial benefits on positive health outcomes. It was created in response to constructive feedback from primary care healthcare provider stakeholders.

Primary Care First is crafted so that it may also be used as a research study to examine whether altering how Medicare pays for primary healthcare would reduce Acute Hospital Usage (AHU) and substantially reduce medical costs while maintaining or enhancing the value and performance of care.

Interestingly, CPC+ and PCF plans involve a demographically segmented payment for every patient assigned to the practice to boost total income for primary care settings, including healthcare practitioners and practices. The scheduled payment facilitates the clinic in obtaining extra resources to fulfill patients’ requirements beyond routine medical appointments. Consider it telehealth, coordinated care, and patient participation.

Primary Care First allows practices to earn a considerable incentive and boost their net revenue from CMS by meeting plan targets. The PCF methodology will be tested for six years, with one batch taking part from 2021 to 2025 and the other from 2022 to 2026. The initial batch is open to practices not currently participating in CPC+ and is situated in one of the 26 qualifying PCF zones. Only existing CPC+ practices will make up the second batch. Primary Care First has roughly 3,000 practices and 24 health insurance provider partners engaged in both sets.

Shifting the focus of financial incentives to performance success rates is one of the new concepts being evaluated by Primary Care First. A straightforward two-tiered payment framework holds practices accountable for their associated recipient demography:

1. A Professional Population-based Payment (PBP) and a Flat Primary Care Visit Fee (FVF) payment are included in the Total Primary Care Payment (TPCP).

2. Performance-Based Adjustment (PBA) is based on two quality indicators: AHU or Total Per Capita Cost (TPCC). The TPCC scale has been developed for use in Primary Care First.

Enhancing compensation for practices that treat patients with complicated, chronic conditions compared to prior Medicare fee-for-service (FFS) payments, PBP is higher for practices that manage patient groups with severe, chronic issues. The greater Professional PBP is designed to cater to higher disease prevalence in these groups and the additional resources needed to treat individuals with numerous chronic health conditions.

Eligibility Criteria for PCF

To be eligible for PCF, practices must satisfy the following requirements:

· Have a minimum of 125 recipients who can be traced back to practice;

· Obtain revenue-based primary care billing criteria.

· Have prior expertise with value-based payment agreements, such as compensation based on quality, cost, and performance.

· Use the 2015 CEHRT, agree to link to their regional health information exchange, and facilitate data sharing with other physicians and healthcare systems via Application Programming Interface.

· Enroll in one of the 26 regions that have been chosen.

PCF Elements of Care Delivery Plan

PCF primary care providers are rewarded for performing five primary care functions at a significantly lower cost:

(1)   Access and continuity

Patients must have easy access to therapy and get it regularly. A patient can call a member of their care team if they have a need (access is available 24 hours a day, seven days a week). That staff member must have access to the data in the EHR. Patients must be referred to a specific care team as part of the emplacement process. Practices should connect with patients via a range of modalities, including telehealth, email, text messaging, other effective communication techniques, and face-to-face appointments.

(2)   Care management

It is necessary to create and implement sophisticated patient care management approaches. Begin with proactive help and comprehensive care management after enrolling high-risk patients. Cases of acute needs must be provided with short-term (episodic) care management, including post-discharge follow-up and medication adjustment. It’s also critical to managing the care transition process for people moving from one healthcare environment to another.

(3)   Comprehensiveness and coordination

Patients’ needs should be considered holistically, and practices should interact across the healthcare system, emphasizing cognitive, social, and health problems. Techniques are required to work with community members to meet the needs of patients. As the relevance of outcomes grows, coordinated efforts, including primary care and practitioners, become more significant, and achieving patient objectives becomes the top priority.

(4)   Patient and caregiver engagement

Employ patient and care provider interaction techniques to assist the practice in fostering patient-centered excellence. A Patient and Family Advisory Council (PFAC) is one approach to do this. It is a community of old and new patients, families, and care providers who help each other. Through training, tools, and responsibility, patients’ “self-management” should be facilitated by practices and clinicians.

(5)   Planned care and population health

The final strategy of holistic primary care is to use data to optimize practice. In any context, evaluation is crucial for progress. To keep the pace and generate better priorities, regularly analyze and reply to inquiries and regularly assess preparation and practitioner data from CMS and other private insurers. Data should drive testing methodologies to boost care and meet the CMS project’s objectives.

Conclusion

Being a part of PCF gives several advantages, including significantly more excellent financial support that allows a practice to concentrate on enhancing outcomes while also having the freedom to explore novel therapeutic strategies.