Earlier this year, the Center for Medicare and Medicaid (CMS) announced five new payment models designed to transform primary care by paying providers for outcomes rather than services. One of the payment models is the Primary Care First (PCF) Model which is a voluntary, five-year alternative payment model (APM) aimed at reducing Medicare spending via prevention of acute hospital utilization, improving doctor-patient relationship, improving care for patients with complex chronic needs, and seriously ill patients.
The PCF model consists of two payment options in which eligible providers can choose to participate in either one or both. The first “General” (PCF-General) option introduces higher payment for primary care practices caring for complex, chronically ill patients and the second “High Need Population” also known as the “Seriously Ill Population” (PCF-SIP) option, encourages advanced primary care practices that typically provide hospice or palliative care services to take responsibility for a high-need population.
Eligible practices will have an opportunity to increase their revenue with geographically adjusted performance-based payments and will be focusing on a single outcome measure, acute care hospitalization. Practices also have the potential to become a Qualifying APM participant.