Medicare’s New Primary Care Model Includes Payment for Specialists
To incentivize collaborations, the Centers for Medicare & Medicaid Innovation (Innovation Center) included payments for specialists as part of the design for its newest model, Making Care Primary (MCP). The purpose of these payments is to support ongoing communications and collaborations of patients the specialist shares with the MCP participant. This design feature is also part of a larger specialty integration strategy the agency implements throughout its various models.
MCP Background
Announced on June 8, the MCP is a voluntary primary care model that will be tested in eight states (Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington). The 10.5-year multi-payer model will launch on July 1, 2024.
Participants of this upside-only model will be eligible for enhanced payments greater than standard fee-for-service payments. They will also be equipped with tools and supports to improve the health outcomes of their patients. The model is designed with three progressive tracks:
Track 1 –Building Infrastructure
Track 2 – Implementing Advanced Primary Care
Track 3 – Optimizing Care and Partnerships
Participants will select a track based on their value-based experience as part of the application process. Track 1 is designed for those with no prior value-based experience. Financial support and potential reimbursement vary by track.
Ambulatory Co-Management (ACM) Code
Under this model, specialists with a Collaborative Care Arrangement with an MCP participant can bill the ACM code. This code supports ongoing communications and collaborations of patients shared with an MCP participant. This $50/per month payment, subject to geographic adjustment, will be billed for shared patients requiring longitudinal primary care and short-term specialized care to stabilize exacerbated chronic conditions.
MCP participants in Tracks 2 and 3 would be expected to bill eConsults to capture the time to implement a specialist’s recommendation. This is billed at $40/per service and is also subject to geographic adjustment.
In addition to these payment mechanisms, the model includes other features to support the Innovation Center’s specialty integration strategy. Model participants will be provided with performance data on specialists in their region (prioritizing cardiology, pulmonology, and orthopedics). They will also be offered peer-to-peer learning opportunities with specialists at both the national and state/regional level
Model Timeline
These model details were discussed during a June 27 webinar hosted by the Innovation Center. During this webinar, Innovation Center staff also shared their current timeline for the model’s application and implementation process.
Next few weeks: More details on the model will be released
August 2023: The model application portal will be open (potentially until the end of the year)
Early 2024: Participants will be contacted
April 2024: Onboarding will begin
July 1, 2024: Program launch
Please watch this website for further updates and bookmark the MCP model homepage.
For more information and questions, please contact:
Sheila Madhani, MA, MPH
Madhani Healthcare Consulting, LLC
Email: smadhani@madhani-health.com
www.madhani-health.com
Tel: (202) 679-2977.