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Primary Care First Model Cohort 2

Sponsor
Centers for Medicare and Medicaid Services
Deadlines
May 21, 2021
Contact
Purpose

The Primary Care First Model (PCF) is a voluntary 5-year payment option that rewards value and quality by offering an innovative payment structure to support delivery of advanced primary care. Participating practices will generally include primary care practitioners, as well as other clinicians that are managing complex, chronically ill and seriously ill populations. Cohort 2 is scheduled to begin in January of 2022.

The Primary Care First tests the concepts:

  • Shifting focus of payment incentives to outcomes - Practices will be accountable for their attributed beneficiary population through a 2-tiered payment structure: (1) A total primary care payment, consisting of a population-based payment and flat primary care visit fee; and (2) A performance-based adjustment tied to specified outcome measures
  • Increasing reimbursement for practices caring for patients with complex, chronic needs, relative to historical aggregate Medicare fee for service (FFS) revenue

Performance-based adjustments reward practices that :

  • Exhibit a high standard of performance and quality
  • Excel compared to peer practices and improve over time
  • Improve or maintain high quality outcomes
Eligibility

The Primary Care First payment model option is designed for primary care practices with advanced primary care capabilities that are prepared to accept increased financial risk in exchange for flexibility and potential rewards based on practice performance. Eligible practitioners are those in internal medicine, general medicine, geriatric medicine, family medicine, and/or hospice and palliative medicine. Additional eligibility requirements for Cohort 2 are listed on the program website.

The model is available in 26 regions as listed on the program website.

Geographic coverage
Available in 26 regions.
Amount of funding

Payment will be provided to practices through a two element payment structure, including:

  • The Total Primary Care Payment (TPCP) that includes a prospective professional population-based payment (PBP) paid on a quarterly basis and a flat $40.82 base rate per-visit primary care fee
  • A performance based adjustment based on the participant's performance on acute hospital utilization (AHU) or total per capita cost (TPCC), as well as whether the practice meets or exceeds minimum performance on a set of pre-defined quality measures each year

Payment is illustrated is Tables 2-4 of the application instructions.

Application process

Visit the program website for application instructions and links to additional information.

Apply online using the Practice and Payer Application Portal.

The practice solicitation period for PCF Cohort 2 will close on May 21, 2021. The payer solicitation period for PCF Cohort 2 will close on June 18, 2021.

Webinars:

Webinar recordings:

Tagged as
Healthcare quality · Medicare · Primary care · Reimbursement and payment models · Service delivery models · Alaska · Arkansas · California · Colorado · Delaware · Florida · Hawaii · Kansas · Kentucky · Louisiana · Maine · Massachusetts · Michigan · Missouri · Montana · Nebraska · New Hampshire · New Jersey · New York · North Dakota · Ohio · Oklahoma · Oregon · Pennsylvania · Rhode Island · Tennessee · Virginia



For complete information about funding programs, including your application status, please contact funders directly. Summaries are provided for your convenience only. RHIhub does not take part in application processes or monitor application status.