Getting you up-to-speed for the all-new Primary Care First Program

Primary Care First

Primary Care First (PCF) is an innovative payment model created by the Centers for Medicare and Medicaid Services (CMS) to encourage the high performance and delivery of extraordinary primary care services.

PCF members must provide data on specified quality metrics annually, including the quality indicator Advance Care Plan (ACP), which needs reporting from a Qualified Registry or QCDR vendor, which is not an EHR disposable indicator.

Maintaining High-Quality Performance and Reporting

If the practice has so far earned the designation of Patient-Centered Medical Home (PCMH), undoubtedly, it is on its way to becoming an advanced primary care provider.

However, those healthcare organizations that don’t have a robust technology solution and partner who understand the program requirements and can help meet the criteria to succeed in it will need to take action now.

Organizations willing to participate in the PCF program must prepare themselves now. We suggest taking the following measure to dive into the program head-on.

1)      A Qualified Registry or QCDR Vendor Must Be Selected

To obtain a performance bonus, participating providers must use a certified registry from the MIPS Final Approved List of qualified registries and qualified clinical data registries to submit the Advance Care Plan measure.

Persivia, as a CMS-approved Qualified Registry, can assist PCF registrants by reporting the ACP and other eCQMs on their behalf. Persivia can perform aggregation, computation, validation, and metrics delivery for its clients.

2)      Remember To Keep an Eye on AWV

The Annual Wellness Visit (AWV) enables healthcare providers to learn more about their patients’ health histories, risks, and physical findings. The AWV aims to assess the patient’s well-being and provide a tailored prevention approach.

Persivia’s Care Management solution allows providers and caregivers to keep track of reimbursement programs like AWV through task automation and multichannel communication.

3)      Evaluating Actual Performance Based on Primary Care Quality Metrics

To be eligible for a positive performance-based adjustment (bonus), healthcare providers must reach or surpass the average national level of performance on a specific set of clinically essential quality metrics for patients.

The user-friendly interface of Persivia, and its practical and successful rules engine, may assist participants in keeping track of their performance for the critical quality metrics. Persivia’s skilled clinical and implementation team may work with participating providers in meeting reporting criteria while also identifying and addressing data documentation gaps.

4)      Plan to Set Up a Competitive RCM Workforce

Billing issues are probably due to documentation and coding errors, which cause an increase in claims. Changes in billing and coding must be emphasized by developing strategies to maintain or enhance patient HCC coding by compensating the Revenue Cycle Management (RCM) workforce.

Persivia’s HCC Coding solution performs retrospective and prospective clinical documentation reviews to ensure that all relevant diagnoses are recorded. It assists in data gathering and cares gaps closure, thereby boosting risk scores and maintaining efficient and effective care delivery.

5)      Boost the Effectiveness of the Care Management Staff

Determine a systematic approach for providing coordinated care consistently to patients who require careful management to avoid risks. The most effective method is to assign responsibilities and performance objectives across the practice.

Persivia provides 3rd generation Care Management capabilities that equip care providers with relevant information and insights across the entire care continuum and automate tasks and workflows to help increase their efficiency.

6)      PCF Practices Can Benefit Financially from PBPM Payments

The monthly professional-based payment – per beneficiary per month (PBPM) is determined by the average Hierarchical Condition Categories (HCC) score. It varies from $24 to $175 per month for an average HCC of less than 1.0 to more than 2.0 HCC. Most practices receive between $28 and $34 per beneficiary every month.

Through NLP and machine learning algorithms, Persivia’s AI-driven risk adjustment solution can significantly improve patients’ HCC and RAF scores which turn into more payout and improved risk management.

Persivia – a Trusted Partner for PCF Participants

Persivia provides the expertise and technology needed by organizations participating in the PCF program to help make the reporting easier, increase payments, and deliver the best care.