New CMS Primary Care Model Goes Big On Chronic Care Management

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New CMS Primary Care Model Goes Big On Chronic Care Management
by Daniel Tashnek

The Centers for Medicare & Medicaid Services (CMS) has announced a new voluntary primary care initiative that further demonstrates its intent to invest in and grow chronic care management (CCM).

The Making Care Primary (MCP) Model is intended to strengthen care coordination between primary care clinicians, specialists, social service providers, and behavioral health clinicians around chronic disease management, with goals of increasing prevention of chronic disease, reducing emergency room visits, and achieving better outcomes.

Through MCP, participants will receive additional revenue as well as tools and support to build infrastructure, make primary care services more accessible, and improve care coordination with specialists.

The MCP Model is built on the following three domains:

  1. Care Management: focuses on managing chronic diseases, such as diabetes and hypertension, and reducing unnecessary emergency department use.
  2. Care Integration: emphasizes improving patient care and care coordination through stronger connections with specialty care clinicians and evidence-based behavioral health screening.
  3. Community Connection: aims to identify and address health-related social needs (i.e., social determinants of health (SDoH)) and connect patients with community support and services​

Here are some other key things to know about the new MCP Model:

  • It's set to launch on July 1, 2024.
  • CMS will begin accepting applications for the MCP Model in late summer 2023.
  • The model will run 10.5 years, from July 1, 2024, to Dec. 31, 2034.
  • It will be initially tested in eight states: Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington.
  • CMS is currently engaged with state Medicaid agencies and other payers in these states to develop programs that align with the MCP Model.
  • While CMS is implementing MCP for Medicare beneficiaries, the agency is hoping other payers will partner with CMS in support of the program and expanding its access and reach. 

New Making Care Primary Model: Key Takeaways

The development and pending launch of this new primary care model is further proof that CMS intends to continue supporting care management services for both fee-for-service reimbursement and increasingly as a staple of value-based care. CMS's focus on addressing health-related social needs (HRSNs) and SDoH while working to best ensure patients receive the necessary community support and services to help improve prevention, screening, and management of chronic conditions is encouraging. Considering these goals align perfectly with the objectives of chronic care management, it's apparent that CMS views CCM as a valuable service worthy of increased investment.

Even though the Making Care Primary Model is not a large pilot program to start, the decision by CMS to commit to it in eight states and for more than a decade gives us insight into where the agency is going, which is squarely towards more care management. Follow Prevounce on LinkedInTwitter, and Facebook to make sure you receive additional information about this new primary care model as it becomes available.

You can learn more about the MCP Model on the CMS website.

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