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HOW TO GET STARTED WITH THE MAKING CARE PRIMARY MODEL

by VirtualHealth | Medicare Advantage, Value Based Care





TRACK 1: BUILDING THE INFRASTRUCTURE FOR BETTER VALUE-BASED PRIMARY CARE

CMS recently announced its new Making Care Primary (MCP) model, a voluntary
initiative set to launch in July 2024 among selected participants in eight
states. As of September 2023: “CMS is working with State Medicaid Agencies in
eight states – Colorado, North Carolina, New Jersey, New Mexico, New York,
Minnesota, Massachusetts and Washington – to engage in full care transformation
across payers, with plans to engage private payers in the coming months.”
Source: CMS


KEY OBJECTIVES OF THE MCP MODEL

 1. Continue paving the way for organizations to move from fee-for-service (FFS)
    payment to prospective, population-based payment.
 2. Strengthen primary care infrastructure to better integrate specialist and
    behavioral health care, as well as drive more equitable access to
    healthcare.
 3. Improve care management and care coordination.
 4. Better equip primary care clinicians to partner with health care
    specialists.
 5. More frequently and effectively leverage community-based connections and
    programs designed to address health and health-related social needs (such as
    critical social determinants of health (SDOH) including housing and
    nutrition).


TRACK 1: LAYING THE FOUNDATION FOR VALUE-BASED PRIMARY CARE

The MCP model comprises three separate tracks that guide participants along a
progressive transformation to providing value-based care. According to CMS,
Track 1 is designed for participants with no prior value-based care experience.

If you’re just getting started with value-based care, taking note of Track 1
goals can help guide key steps and measures to focus on.

TRACK 1 GOALS AND PERFORMANCE MEASURES

Track 1 helps participants develop a foundation for shifting toward value-based
primary care services through the following:

 * Data integration
 * Risk stratification of the patient population
 * Workflow development
 * Health-related social needs (HRSN) screenings and referrals
 * Chronic disease management

Meanwhile, Track 2 focuses on implementing advanced primary care, and Track 3
moves participants into optimizing care and partnerships.

CMS also has proposed performance measures across varying areas of focus to
track success. Here are the ones specific to Track 1 participants:

 * Control of high blood pressure and diabetes (chronic conditions focus area)
 * Colorectal cancer screening (wellness and prevention focus area)
 * Person-Centered Primary Care Measure (person-centered care focus area)


CAN THE RIGHT CARE MANAGEMENT SOLUTION CAN GET YOU ON TRACK FOR VALUE-BASED
CARE?

Yes. The right care management platform can help healthcare payers meet key MCP
Track 1 objectives and build a stronger foundation for value-based care
delivery.

Here are five ways a care management platform can enable whole-person care,
improve outcomes, and reduce healthcare overutilization and costs.

1. Data interoperability to power coordination and collaboration. A platform
capable of helping payers to achieve healthcare interoperability and adopt FHIR®
is critical. VirtualHealth just launched the first-ever FHIR® Integration
Platform as a Service (FiPaaS) called HELIOShub. HELIOShub helps payers quickly
and easily connect and transform all their critical data into formats that meet
the HL7® FHIR® standard, without either specialization or heavy lifting by IT
teams. It was designed intentionally with self-management in mind with
configurable data transformations, mapping, and transfer methods that translate
to faster delivery, rapid time to market, and reduced implementation and
maintenance costs. [Learn more about HELIOShub here.]

2. Comprehensive member/patient views across the entire care continuum.
HELIOS collects data from multiple sources, giving all participants in an
individual’s care, from primary care to clinical specialists to behavioral and
social services providers, a complete, accurate, and real-time 360°-view of each
patient. Working from the complete, real-time story of an individual’s health,
including goals, up-to-date diagnoses and treatments, barriers, and progress
notes, helps lead to more effective, coordinated care experiences and better
health outcomes.

3. Population health management tools to support complex population health
needs. A population health solution that provides comprehensive population
analytics and reporting, population and cohort-level analysis capabilities, SDOH
data and analysis integrations, smart target assessments for social and
behavioral health, along with configurable, automated workflows, and advanced
population stratification and risk scoring. Even better is choosing a platform
that is NCQA prevalidated for population health management (like HELIOS).

[View some of the key features for population health in HELIOS including
resources and tools for proactively identifying and addressing social
determinants of health (SDOH).]

4. Automated workflows, diagnosis-based referral creation, and configurable
assessments and risk triggers streamline and improve chronic disease management.
Especially important for Medicaid and Medicare populations, such tools can help
payers better manage and care for people with complex chronic conditions such as
diabetes, or who have more complex health needs. In-platform referrals, the
generation of assessments, automated task assignment and reminders, and clinical
decision-making pathways that include evidence-based best practices are a few
examples. Learn more here.

5. Built-in tools and support for health-related social needs. A care management
platform can help primary care providers integrate more seamlessly with
community partners – resulting in timely connection of patients with needed
services that meet SDOH needs. A platform vendor that provides these within
their solution is a valuable option for healthcare organizations of every size.
See how FindHelp and VirtualHealth work together to help payers address critical
SDOH needs.





MAKING CARE PRIMARY GOALS: TAKE NOTE

While it’s true that this new model will affect select Medicaid populations for
now, it’s a strong indicator of CMS’ continued focus on a collaborative care
management approach as a central driver of value-based care (value-based care).
Consider some of the key goals of MCP and how they align with efforts that are
foundational to delivering value-based care:

To enable comprehensive primary care that’s tightly coordinated with all
specialists involved in an individual’s healthcare (including clinical,
behavioral health, and social service providers), thereby improving quality and
population health outcomes

To prioritize preventive care that helps patients avoid costly outcomes like
developing chronic disease, emergency department (ED) visits, and
re-hospitalizations

To enhance the ability of primary care providers to support patients’ unmet
social and non-clinical needs that impact health (i.e., social determinants of
health, or SDOH)

As CMS sums up in its Request for Applications, the model’s care delivery design
is intended to help participants deliver equitable, team-based care and improve
outcomes over time on key metrics like hypertension and diabetes control,
depression, ED visits, and total cost of care.

Get on track for value-based primary care with HELIOS° by VirtualHealth.

 


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TRACK 3 OF THE MAKING CARE PRIMARY MODEL: ENABLE AND OPTIMIZE CONTINUOUS CARE
COORDINATION

Track 3: Using Quality Improvement Frameworks to Optimize Care Delivery and Gain
Financial Benefits In our last few blogs, we’ve been looking at CMS’ new Making
Care Primary (MCP) model, which aims to have Medicaid advance value-based care
at the primary care level...

read more


TRACK 2 OF THE MAKING CARE PRIMARY MODEL: INTEGRATING & EXPANDING CARE SERVICES

Track 2: Implementing Advanced Primary Care CMS’ recently announced Making Care
Primary (MCP) model advances the agency’s drive to shift from a fee-for-service
model to a value-based care model. The MCP model takes a tiered approach, with
three tracks of...

read more


FUTURE OF CARE CHAT – EXCLUSIVE: BEHIND THE SCENES OF CREATING HELIOSHUB

Creating the first FHIR® Integration Platform as a Service offering Many
healthcare organizations are working hard to improve interoperability and bring
data into compliance with HL7® FHIR® standards. However many of the data
interoperability “solutions” on the market...

read more


FUTURE OF CARE CHAT – EPISODE 6: RESOURCES & THE CHALLENGE IN ACHIEVING
HEALTHCARE DATA INTEROPERABILITY

Why is healthcare data interoperability so difficult to achieve? The technical
staff currently needed to manage healthcare data exchange to meet
interoperability standards and requirements is extensive, burdensome, and
costly. A streamlined FHIR® data solution could...

read more


FUTURE OF CARE CHAT – EPISODE 5: REASONS WHY FHIR® MATTERS IN THE MODERN
HEALTHCARE DATA EXCHANGE

Why does FHIR® matter so much in the modern healthcare data exchange? A
conversation with VirtualHealth product team leaders about the different reasons
why FHIR®matters in the modern healthcare data exchange. There are a number of
reasons why the HL7® FHIR® standard...

read more

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