Cultivate a distinct, overarching strategy for transitioning to value-based care and payment.

Primary Care First

We Offer Coaching and Facilitation to Optimize Performance and Total Medicare Payments

Through our experience as CPC+ National Learning Network Faculty and Regional Practice Facilitators, and as part of the PCF Practice Network, HealthTeamWorks understands the challenges primary care faces in responding to alternative payment model (APM) requirements. We believe value-based payment aligns with the delivery of high-quality care, and we guide practices to establish an unique overarching strategy for transitioning to value-based care and payment.

Download the Info Sheet

About Primary Care First

CMS’ Primary Care First (PCF) is a five-year payment model addressing the need to preserve and strengthen primary care for Medicare beneficiaries. The goal of this payment model is to reduce spending on acute hospital utilization (AHU), total per capita cost (TPCC) and improve access to high-quality care in advanced primary care practices.

The model design prioritizes the care team-patient relationship, enhancing support for patients with complex chronic needs and focusing financial incentives on improved health outcomes.

  • Access and continuity
  • Care management
  • Comprehension and coordination
  • Patient and caregiver engagement
  • Planned care and population health

Practice Coaching and Facilitation

  • Achieving Quality Gateway Performance
  • Improving the Patient Experience
  • Managing Attribution and Addressing Leakage
  • Improving Days at Home Measure
  • Reducing Acute Hospital Utilization (AHU)
  • Lowering Total Per Capita Cost (TPCC)
  • Improving Coding and Documentation for Accurate HCC Risk Adjustment
  • Navigating CMS Data Feedback Tool (DFT)
  •  Expanding and Reporting Advance Care Planning

Financial Resilience Coaching

  • Monitoring Across Disparate Data Sources
  • Planning Strategy and Operational Alignment
  • Analyzing Return on Investment Opportunities

How Can We Help Your Team Work?