FEATURE · POPULATION HEALTH MANAGEMENT value-based care, including Federally


Qualifi ed Health Centers (FQHCs) and physician practices with limited experience in value-based care, as CMS continues to work to reduce disparities in care and drive better patient experience and outcomes.” “Ensuring stability, resiliency, and


access to primary care will only improve the health care system,” CMS Deputy Administrator and Center for Medicare and Medicaid Innovation Director Liz Fowler said, in a statement included in the announcement. “The Making Care Primary Model represents an unprec- edented investment in our nation’s primary care network and brings us closer to our goal of reaching 100% of Traditional Medicare benefi ciaries and the vast majority of Medicaid benefi ciaries in accountable care arrangements, including advanced primary care, by 2030.” The press release went on to note


that “The model includes a progressive three-track approach based on partici- pants’ experience level with value-based care and alternative payment models. Participants, which include FQHCs, Indian Health Service facilities, and Tribal clinics, among others, in all three tracks will receive enhanced pay- ments, with participants in Track One focusing on building infrastructure to support care transformation. In Tracks Two and Three, the model will include certain advance payments and will offer more opportunities for bonus payments based on participant performance. This approach will support clinicians across the readiness continuum in their tran- sition to value-based care, furthering CMS’s goal to ensure 100% of traditional Medicare benefi ciaries are in a care relationship with accountability for quality and total cost of care. Primary care organizations within participating states may apply when the application


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opens in late summer 2023. The model will launch on July 1, 2024.”


Reactions The announcement elicited diverse reac- tions from associations representing physicians and other providers involved in value-based contracting. On the one hand, APG, America’s Physician Groups, the Washington, D.C.- and Los Angeles- based association representing physician groups engaged in value-based contract- ing, released a statement Thursday prais- ing the announcement. Susan Dentzer, APG’s president and CEO, said that “America’s Physician Groups salutes the Centers for Medicare & Medicaid Services on its announcement today of the Making Care Primary Model, which will launch in 2024. Holding primary care physicians accountable for costs and quality is central to achieving the promise of value-based health care. It’s therefore important to continue to provide accessible “on ramps” for small practices to enable them to make what could otherwise be a diffi cult transi- tion for them. “We at APG are especially excited


that Track 1 of the model is explicitly designed for federally qualifi ed health centers, which serve some of the nation’s most vulnerable patients. The model seeks to align payment across Medicare, Medicaid, and commercial payment where possible. These approaches are also vital to stimulating the spread of value-based care.” Furthermore, “Long-term models such


as this one, which will last up to 10 years, will offer stability to participants and may therefore ensure greater participa- tion,” Dentzer added. APG’s members are value sophisticates, and we look forward to one day welcoming veterans of the Making Care Primary model into our membership ranks once they have


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mastered the basics of value and can fl ourish in that environment.” But NAACOS, the Washington,


D.C.-based National Association of ACOs, released a statement attributed to its president and CEO, Clif Gaus, Sc.D., criticizing the move. “NAACOS is committed to increasing investment in primary care and has called for CMS to establish an option for ACOs to implement population-based pay- ments for primary care,” Gaus stated. “The approach we’ve offered would help CMS meet its stated goal of putting all benefi ciaries in a relationship with a provider responsible for total cost of care and quality while increasing invest- ment in primary care. The Making Care Primary Model is counter to these goals by excluding practices who work in an ACO. While aspects of the new model are positive, practices should not be forced to choose between Making Care Primary and participating in an ACO. Within ACOs, primary care practices are the quarterback of care teams, but they must work with providers across the care continuum to achieve quality outcomes and cost savings. Working with ACOs has proven to be benefi cial to primary care practices, and ACOs with practices concurrently participating in primary care models, such as Primary Care First or the Maryland Primary Care Program, are the most successful.” Further, Gaus said, “To continue the


shift to total cost of care models like ACOs, CMS needs to allow concurrent participa- tion or make comparable options within the Medicare Shared Savings Program to coincide with the start of Making Care Primary. In the absence of a population- based payment option for ACOs, practices may choose to move to Making Care Primary rather than remaining in total cost of care models.” HI


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