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* Making Care Primary (MCP) Model
MAKING CARE PRIMARY (MCP) MODEL
On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a
new voluntary primary care model – the Making Care Primary (MCP) Model – that
will be tested in eight states. Launching July 1, 2024, the 10.5-year model
improves care management and care coordination, equips primary care clinicians
with tools to form partnerships with health care specialists, and leverages
community-based connections to address patients’ health needs as well as their
health-related social needs (HRSNs) such as housing and nutrition. 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.
MODEL OVERVIEW
The Making Care Primary (MCP) Model is a 10.5-year multi-payer model with three
participation tracks that build upon previous primary care models, such as the
Comprehensive Primary Care (CPC), CPC+, and Primary Care First (PCF) models, as
well as the Maryland Primary Care Program (MDPCP). MCP aims to improve care for
beneficiaries by supporting the delivery of advanced primary care services,
which are foundational for a high-performing health system. The MCP Model
provides a pathway for primary care clinicians with varying levels of experience
in value-based care to gradually adopt prospective, population-based payments
while building infrastructure to improve behavioral health and specialty
integration and drive equitable access to care. State Medicaid agencies will
commit to designing Medicaid programs to align with MCP in key areas. This model
attempts to strengthen coordination between patients’ primary care clinicians,
specialists, social service providers, and behavioral health clinicians,
ultimately leading to chronic disease prevention, fewer emergency room visits,
and better health outcomes.
HIGHLIGHTS
* MCP provides primary care clinicians with enhanced model payments, tools, and
supports to improve the health outcomes of their patients. It provides
additional resources and data to help primary care clinicians better
coordinate care with specialists. Additionally, it supports better care
integration, meaning that clinicians can more seamlessly address physical and
behavioral health needs and tap into community networks to reduce health
disparities.
* MCP aims to ensure that patients receive care to meet their health goals and
social needs. Patients receive enhanced support from MCP participants to
better manage their conditions and improve their overall wellness.
MODEL PURPOSE
Primary care clinicians are the first line of defense for prevention, screening,
management of chronic conditions, and overall wellness. Patients are
increasingly diagnosed with multiple chronic conditions, which only intensifies
the importance of accessible, affordable, high-quality primary care teams that
can help anchor their overall health care. However, care coordination is
increasingly challenging as patients see a greater number of specialists more
frequently. Through MCP, the Center for Medicare and Medicaid Innovation (the
Innovation Center) increases the investment in primary care so patients can
access more seamless, high-quality, whole-person care.
The MCP Model meets primary care organizations where they are through its
progressive, three-track approach to begin transforming care and improving
outcomes for their patients. This includes several payment innovations to
support participants in delivering advanced primary care. To support team-based
care, MCP includes prospective payments for primary care that will reduce
organizations’ reliance on fee-for-service payments. Risk-adjusted enhanced
services payments, which are paid prospectively and represent an additional
investment in primary care, allow participants to expand care management, screen
for health-related social needs, and integrate with specialty care. MCP includes
Federally Qualified Health Centers (FQHCs) in a multi-state advanced primary
care model for the first time, as well as other organizations serving Medicare
beneficiaries with complex health and social needs to further this goal. For
these participants, the model features upside-only performance incentives that
allows participants to be rewarded for their work to improve quality and cost
outcomes for their patients. The quality performance measures included in MCP
reflect the work of CMS to streamline measures across programs and test new and
innovative measures.
The MCP care delivery approach communicates its vision for care delivery through
three domains:
* Care Management: participants build their care management and chronic
condition self-management support services, placing an emphasis on managing
chronic diseases such as diabetes and hypertension, and reducing unnecessary
emergency department (ED) use and total cost of care.
* Care Integration: in alignment with CMS’ Specialty Integration Strategy,
participants strengthen their connections with specialty care clinicians
while using evidence-based behavioral health screening and evaluation to
improve patient care and coordination.
* Community Connection: participants identify and address health-related social
needs (HRSNs) and connect patients to community supports and services.
Each of these domains has specific care delivery requirements for participating
organizations in each track.
MODEL DESIGN
MCP’s three progressive tracks are designed to recognize participants’ varying
experience in value-based care—from under-resourced participants to those with
existing advanced primary care experience in alternative payment models. MCP
aims to give these organizations flexibility, allowing them to choose their
participation track and receive payments that reflect each participant’s
experience towards accountable care. Again, MCP is a three-track model with one
track reserved for organizations with no prior value-based care experience.
* Track 1 –Building Infrastructure: Participants will begin to develop the
foundation for implementing advanced primary care services such as
risk-stratifying their population, reviewing data, building out workflows,
identifying staff for chronic disease management, and conducting
health-related social needs screening and referral. Payment for primary care
will remain fee-for-service (FFS), while CMS provides additional financial
support to help participants develop care transformation infrastructure and
build advanced care delivery capabilities. Participants can begin earning
financial rewards for improving patient health outcomes in this track.
* Track 2 – Implementing Advanced Primary Care: As participants progress to
Track 2, they will build upon the Track 1 requirements by partnering with
social service providers and specialists, implementing care management
services, and systematically screening for behavioral health conditions.
Payment for primary care will shift to a 50/50 blend of prospective,
population-based payments and FFS payments. CMS will continue to provide
additional financial support at a lower level than Track 1, as participants
continue to build advanced care delivery capabilities. Participants will be
able to earn increased financial rewards for improving patient health
outcomes.
* Track 3 – Optimizing Care and Partnerships: In Track 3, participants will
expand upon the requirements of Tracks 1 and 2 by using quality improvement
frameworks to optimize and improve workflows, address silos to improve care
integration, develop social services and specialty care partnerships, and
deepen connections to community resources. Payment for primary care will
shift to fully prospective, population-based payment while CMS will continue
to provide additional financial support, at a lower level than Track 2, to
sustain care delivery activities while participants have the opportunity to
earn greater financial rewards for improving patient health outcomes.
ELIGIBILITY CRITERIA
To be eligible to apply to participate in MCP, an organization must:
* Be a legal entity formed under applicable state, federal, or Tribal law
authorized to conduct business in each state in which it operates.
* Be Medicare-enrolled.
* Bill for health services furnished to a minimum of 125 attributed Medicare
beneficiaries.
* Have the majority (at least 51%) of their primary care sites (physical
locations where care is delivered) located in an MCP state.
Rural Health Clinics, concierge practices (practices that collect a fee from
patients for access to their services), current Primary Care First (PCF)
practices, current ACO REACH Participant Providers, and Grandfathered Tribal
FQHCs are not eligible for MCP. Organizations will not be able to concurrently
participate in the Medicare Shared Savings Program and MCP after the first six
months of the model.
STATE PARTICIPATION IN MCP
Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, North
Carolina, and Washington were selected after reviewing criteria related to
geographic diversity, health equity opportunity, population, current CMS
Innovation Center footprint, generalizability to the rest of the Medicare
population for model evaluation, and the ability to align with state Medicaid
agencies. CMS provided further details about state-specific eligibility criteria
for applicants in the Request for Applications (RFA).
This interactive map allows you to select any area to view more detailed
information. Use the legend to understand the map symbols and colors.
Select anywhere on the map below to view the interactive version
Created with Raphaël 2.3.0Participants
Created with Raphaël 2.3.0 and Mapael undefined
(https://www.vincentbroute.fr/mapael/)
Source: Centers for Medicare & Medicaid Services
Participants:Dark Blue: Making Care Primary (MCP) Model, ]
0
* Download the MCP Model participant list (XLSX)
* Download the MCP Payer Partner List (PDF)
MULTI-PAYER ALIGNMENT
We are partnering with state Medicaid agencies and other payers in the listed
MCP states to align MCP and state programs. While CMS is implementing MCP for
Medicare beneficiaries as described in the RFA, other payers are encouraged to
partner with CMS to realize the goals and elements of improved primary care
across all patients, including those covered by Medicaid, commercial, and other
payers.
HEALTH EQUITY STRATEGY
The Innovation Center believes that equitable care is crucial to achieving
high-quality care for Medicare and Medicaid beneficiaries and is, therefore
critical to MCP’s success. CMS defines health equity as: “the attainment of the
highest level of health for all people, where everyone has a fair and just
opportunity to attain their optimal health regardless of race, ethnicity,
disability, sexual orientation, gender identity, socioeconomic status,
geography, preferred language, or other factors that affect access to care and
health outcomes (PDF).” The term “underserved communities” refers to
populations sharing a particular characteristic, as well as geographic
communities, that have been systematically denied a full opportunity to
participate in aspects of economic, social, and civic life (more information).
MCP includes several model components designed to improve health equity:
* Some payments are adjusted by clinical indicators and social risk.
* Participants are required to develop a strategic plan for how they will
identify disparities and reduce them.
* Participants are required to implement HRSN screening and referrals.
* Participants are allowed to reduce cost-sharing for patients in need.
* CMS measures the percentage of patients screened for HRSNs
* CMS collects data on certain demographic information and HRSNs to evaluate
health disparities in MCP communities.
EVENTS
* Upcoming events will be posted here.
PAST EVENTS
* Making Care Primary (MCP) Office Hour Webinar – April 17, 2024 – Recording
(MP4)
* Making Care Primary (MCP) Learning Deep Dive Webinar – April 10, 2024 –
Recording (MP4)
* Making Care Primary (MCP) Health Equity Deep Dive Webinar – April 3, 2024 –
Recording (MP4)
* Making Care Primary (MCP) Care Delivery Deep Dive Webinar – March 27, 2024 –
Recording (MP4)
* Making Care Primary (MCP) Quality Deep Dive Webinar - March 20, 2024 –
Recording (MP4)
* Making Care Primary (MCP) Payment Deep Dive Webinar – March 13, 2024 –
Recording (MP4)
* Making Care Primary (MCP) Welcome Webinar – March 6, 2024 – Slides (PDF) |
Transcript (PDF) | Recording (MP4)
* Making Care Primary (MCP) Office Hours – November 21, 2023 – Slides (PDF) |
Transcript (PDF) | Recording (MP4)
* Making Care Primary (MCP) Office Hours – October 24, 2023 – Slides (PDF) |
Transcript (PDF) | Recording (MP4)
* MCP Applicant Office Hour - August 21, 2023 – Slides (PDF) | Transcript
(PDF) | Recording (MP4)
* MCP Payer Office Hour - August 8, 2023 – Slides (PDF) | Transcript (PDF)
| Recording (MP4)
* Making Care Primary (MCP) FQHC and Indian Health Program Overview Webinar –
July 20, 2023 – Slides (PDF) | Transcript (PDF) | Recording (MP4)
* MCP Model Overview Webinar – June 27, 2023 – Slides (PDF) | Transcript
(PDF) | Recording - Part 1 (MP4), Part 2 (MP4), Part 3 (MP4)
ADDITIONAL INFORMATION
* MCP Payment Attribution Methodologies (PDF)
* Making Care Primary Performance Incentive Payment Guide (PDF)
* Making Care Primary (MCP) Example Revenues Factsheet (PDF)
* MCP Request for Applications (RFA) (PDF)
* MCP Model Applicant Letter of Intent
* MCP Application User Manual (PDF)
* MCP Application Example (PDF)
* MCP Model Frequently Asked Questions
* MCP Overview Factsheet (PDF)
* MCP Payer Partner Factsheet (PDF)
* MCP Payer Partner Letter of Intent (LOI) (PDF)
* MCP Application Tracks Factsheet (PDF)
* MCP Payer Partners Guide to Alignment (PDF)
* CMS Innovation Center Primary Care Models Comparison (PDF)
* MCP Ambulatory Co-Management Code Quick Reference Guide (PDF)
* MCP e-Consult Code Quick Reference Guide (PDF)
OUTREACH
* If you have questions regarding the Model, you can contact the MCP model team
at MCP@cms.hhs.gov.
* To stay up to date on model announcements, events, and resources, sign up for
the Making Care Primary Model listserv.
MODEL SUMMARY
Stage: Active
Number of Participants: 128 participants, 772 practices
Category: Accountable Care Models
Authority: Section 1115A of the Social Security Act
MILESTONES & UPDATES
July 10, 2024MCP Participants
WHERE HEALTH CARE INNOVATION IS HAPPENING
See who's working with CMS to implement new payment and service delivery models.
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Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa
Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota
Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico
New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode
Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia
Washington West Virginia Wisconsin Wyoming American Samoa Federated States of
Micronesia Guam Midway Islands Northern Mariana Islands Puerto Rico Republic of
Palau Republic of the Marshall Islands U.S. Virgin Islands Models for state
RELATED ITEMS
* Accountable Care Models
ACO Investment Model
Stage: Not Active
Learn More about ACO Investment Model
* Accountable Care Models
ACO Primary Care Flex Model
Stage: Announced - Applications Under Review
Learn More about ACO Primary Care Flex Model
* Accountable Care Models
ACO REACH
Stage: Active
Learn More about ACO REACH
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