The first cohort of practices participating in CMS’ Primary Care First (PCF) Model begins January 2021. Beyond Comprehensive Primary Care Plus (CPC+) and its predecessor CPC ‘classic’, this represents a next step in value-based care and alternative payment models (APMs) for primary care. At the practice level PCF is an opportunity to exercise flexibility in how care is delivered, with an increasing focus on outcomes, aligning value-based delivery with value-based payment.

Across 26 regions, PCF will include this initial cohort as well as a second cohort opening the opportunity for CPC+ practices to apply. While this is an expanded opportunity for primary care along the value continuum, it’s not without risk.

So what should practices be thinking about now?

As a Cohort 1 practice or group of practices, eager to launch into the model, you are no doubt considering the following:

• Acknowledging care delivery interventions and drivers of critical aims are available based on previous primary care models, how will we innovate beyond that to ensure outcome performance compared to our region and our own continuous improvement to avoid downside risk?
• What data is available to us, and how can we make it actionable and usable by our care teams to impact real time changes and know if those changes are resulting in improved performance?
• What steps do we need to take to have the greatest impact on Acute Hospital Utilization (AHU) performance?
• Where do we prioritize and how can we best align our efforts to optimize ROI?
• What support do we need and at what level to ensure our success?

Knowing direct practice support will not be provided as part of participation in the model, practices may decide to seek coaching and facilitation or advice and guidance. HealthTeamWorks is well-positioned to provide this support with flexible design options. See an overview of support options here, or contact us at [email protected] for more information.

As a practice or system contemplating application to Cohort 2, the following is likely top of mind:

• Does the PCF Model make sense for our practice(s)?
• How will PCF be different from and similar to CPC+?
• What financial considerations should I be weighing in this decision?
• Do we have the infrastructure needed to meet performance outcomes?
• What data do we have that can inform our decision to apply?
• How are adjustments calculated?
• What risk group is our practice likely to be in and what does that mean for our payment?

HealthTeamWorks offers a free PCF calculator comparing Medicare payment options FFS, CPC+, and PCF (also includes SIP). Contact us to schedule a brief walk-through and discussion about using your data to explore if application to the PCF Model is right for your practice.

For additional PCF Model information, payment components are described in CMS’ Model Briefing webinar and slides and more comprehensively in the August 2020 PCF Payment and Attribution Methodologies document. Also, see CMS’ Innovation Center PCF Model Options page for more information and materials.

We look forward to connecting with you as you contemplate these important decisions!