The CMS Primary Cares Initiative, being rolled out by officials in the Centers for Medicare & Medicaid Services, spell changes on the horizon for healthcare providers. The initiative is poised to kickstart value-based care, offer five voluntary payment model options, and some significant increases in competition from unlikely places.
Even as some important questions remain unanswered, the CMS Primary Cares Initiative is generating a lot of excitement. Observers say it opens the door to more competitors for healthcare incumbents.
The shift to value-based care has sputtered a bit in the past two years, as hospitals and health systems have waited to see what innovative reforms the Trump administration would push across the healthcare policymaking finish line.
Despite a litany of attempts—and two years of a Republican-controlled Congress—the administration has neither repealed nor replaced the Affordable Care Act and the value-based payment provisions embedded within it. Even with its individual mandate neutralized and its constitutionality under judicial review, the ACA remains law, and officials in the Centers for Medicare & Medicaid Services are using the ACA’s authority to roll out a potentially transformative undertaking: the CMS Primary Cares Initiative.
That initiative, industry stakeholders say, is poised to kickstart value-based care in Medicare and beyond, ushering in a new wave of consumer-centric competition that could help to shake off some healthcare providers’ risk aversion.
“There was a sense that things were flattening out. It wasn’t going backwards. It wasn’t going down. It just was not progressing as fast as we all had hoped,” says Norman H. Chenven, MD, founding CEO of Austin Regional Clinic in Texas and vice chairman of the Council of Accountable Physician Practices.
“With this announcement for Medicare—again, with the caveat that the devil is in the details—there is a sense that this is going to be a shot in the arm and we’re going to see some real new energy, innovation, and evolution of the value-based movement,” Chenven tells HealthLeaders.
The initiative, which CMS announced last month, has a total of five voluntary payment model options split between two paths. There are two options under the Primary Care First (PCF) path and three options under the Direct Contracting (DC) path. The idea behind all five options is to demonstrate how risk and reward can lead to investment in primary care that ultimately reduces overall healthcare spending and boosts quality outcomes.
While there are still key details we don’t know about how the new models will operate, they appear to present opportunities for healthcare providers that are strategically positioned to make big moves in value-based primary care.
But there also seem to be significant threats, including potential competition from some unlikely sources.