Benefits of HBPC HBPC in the News HCCIntel Legislative News

CMS details new primary care payment model with range of risk options

Risk - Reward Model Graphic

  • CMS on Monday announced a new voluntary Medicare payment model for primary care providers. The two-pronged program has paths for small practices and large organizations and a range of options from partial shared risk to full downside risk.
  • The agency projects as many as a quarter of traditional Medicare fee-for-service beneficiaries will be incorporated into the five-year program, called Primary Cares Initiative. It is slated to roll out in January, with a call for applications expected in about a month.
  • CMS is also asking for input on an additional model in the program that would give one organization responsibility for the total cost of care for an entire Medicare population in a geographic area. That model would begin in January 2021.

Center for Medicare and Medicaid Innovation Director Adam Boehler noted in a press conference unveiling the model that primary care makes up only a small fraction of the country’s total healthcare spend (and of Medicare spending), but emphasized its potential to have great affect on downstream costs and quality outcomes.

“A strong primary care foundation is essential to an effective healthcare system broadly,” Boehler said.

HHS Secretary Alex Azar said the Primary Cares Initiative represented a pivotal moment for the agency as it pushes providers toward value-based care arrangements, and he hoped the Medicare program would have ripple effects. “This initiative is specifically designed to encourage state Medicaid programs and commercial payers to adopt similar approaches,” he said at the press conference. Read the full article

Benefits of HBPC HBPC in the News HCCIntel Legislative News Press Releases

New CMMI Models Announced to Support Primary Care for People with Complex Chronic Illness

Secretary of Health and Human Services Alex M. Azar CMS Primary Cares Press Conference

4/24/19  |

The American Academy of Home Care Medicine (AAHCM) is pleased to share initial details on two new Alternative Payment Models (APMs) that promote primary care of Medicare beneficiaries with complex, advanced illness. The high-level outlines of these new APMs were announced on April 22 by the Center for Medicare and Medicaid Innovation (CMMI). The Academy’s media statement is available here. These APMs are part of a new CMS Primary Cares Initiative and will offer a choice of two new payment paths. The new payment demonstrations are meant to promote value-based care, with a voluntary shift of up to 25 percent of primary care Medicare fee-for-service patients to these new models. This e-alert summarizes the information CMS has released to date about the models.  Several important details, such as exact payment amounts and patient eligibility criteria, remain to be announced. We will issue additional alerts to Academy members as soon as information is made available in the coming weeks.


The two new options, Primary Care First (PCF) and Direct Contracting (DC), will offer enhanced payment for home care medicine and other providers to provide primary care for people with advanced illness. The Academy, along with others, has worked closely with CMMI to develop this new payment model, with a focus on relevant quality measures for people with advanced illness and use of outcome-based payment methods.  Many core principles of the successful Independence at Home (IAH) Demonstration are included in Primary Care First. Home care medicine providers and policymakers have learned much from IAH, thanks to the foresight of our champions on Capitol Hill and the CMS leadership.  Read the full article

Benefits of HBPC Event Events HBPC in the News HCCIntel Legislative News Press Releases

HHS Secretary Azar Announces CMS Primary Cares – A Historic Turning Point In American Healthcare

Secretary of Health and Human Services Alex M. Azar CMS Primary Cares Press Conference

April 22, 2019  |

This is the speech (as prepared) delivered by HHS Secretary Alex M. Azar, April 22, 2019 in Washington, D.C.

Good afternoon, everyone, and thank you so much for joining us. Thank you in particular to the American Medical Association for inviting us here to announce today’s news.

It’s appropriate to be at the headquarters of an organization with such a long history in American medicine, because I believe we’ll look back at what we’re announcing today as a historic turning point in American healthcare.

Today’s announcement is the culmination of years of work by many at HHS and throughout American healthcare.

When I announced last year that moving toward a value-based healthcare system would be one of my priorities as secretary, I was well aware that I was at least the fourth HHS Secretary to take this issue seriously, dating back through Secretaries Burwell and Sebelius to Secretary Leavitt, who first laid out the idea of paying for value rather than procedures.

It is only thanks to the efforts of my predecessors that we get to take this major step forward. Today also could not be possible without the enthusiastic engagement of so many physicians and other providers. That includes members of HHS’s advisory committee on physician-focused payment models, PTAC—a member of which we have here today, Kavita Patel.

That committee has analyzed a huge number of payment model ideas from physicians who are excited about innovation. Their work, including submissions from the American Academy of Family Physicians, the American Academy of Hospice and Palliative Medicine, and the Coalition to Transform Advanced Care, has inspired many significant aspects of the initiative we’re announcing today.

So what are we announcing? We’re launching CMS Primary Cares—an initiative with two sets of new payment models that will enroll a quarter or more of traditional Medicare beneficiaries and a quarter of providers in arrangements that pay for keeping patients healthy, rather than ordering procedures.

The Primary Care First path will allow smaller primary care practices to be paid a simple, flat stream of revenue for each patient. When a patient stays healthy and out of the hospital, these practices will get paid a bonus. But if the patient ends up sicker than expected, these practices will bear responsibility for the extra spending, up to a certain share of their practices’ revenue.

The other path, Direct Contracting, is more ambitious and aimed at larger practices. Just like in Primary Care First, when patients have a better experience and stay healthier, these practices will make more money. But if patients end up sicker, Direct Contracting practices will bear the risk for the extra health spending, not just at their own practice but throughout the system.

Providers will have greater flexibility to spend these resources how they want, allowing them to come up with innovative ways to care for patients—and receive significant savings if they keep patients healthier than expected.

Within this initiative, we will also have options for providers who want to focus on particular populations and particular serious illnesses—where there is huge potential for better health outcomes and more savings.

We’re also seeking input on another Direct Contracting model, to award a local entity a contract for an entire geographic area, covering all patients and providers in the area who want to opt into this arrangement.

This would provide an unprecedented ability for that local organization to negotiate better rates than Medicare does today, take responsibility for outcomes, and provide benefits that work for the local community’s needs.

Primary care is a small slice of health spending overall, but it has a significant impact on downstream costs and quality.

This initiative will radically elevate the importance of primary care in American medicine, move toward a system where providers are paid for outcomes rather than procedures, and free doctors to focus on the patients in front of them, rather than the paperwork we send them.

In just a minute, I’ll turn things over to Administrator Verma—I’m sorry to say, she is the one who sends doctors the paperwork, but she’s made sure there’s less and less of it every year.

Then we’ll hear from my senior advisor for value-based transformation and CMMI’s director, Adam Boehler. They’ll both discuss more details about this initiative and the range of options it’s going to offer for patients and clinicians.

Moving in this direction, toward value-based care, has been largely just a vision for so long. Now, value-based care is a reality, for a quarter of traditional Medicare beneficiaries in primary care, and a significant and growing number of patients in other settings as well.

This is the pivotal, hockey stick moment in paying for value in American healthcare.

This initiative will lay the groundwork not just for better care and lower costs in the $700 billion Medicare program and the $580 billion Medicaid program, but will also help drive innovation toward a new, patient-centered approach in our entire $3.5 trillion healthcare system. This initiative is specifically designed to encourage state Medicaid programs and commercial payers to adopt similar approaches.

I believe that true transformation is possible because of the experiences we’ve gained, but also the bold leadership we have today. Read the full speech

Benefits of HBPC HBPC in the News HCCIntel Legislative News

CMS Announces New Primary Care Payment Models Aimed at Greater Shared Risk

Money and medicine

Fierce Healthcare  |  Paige Minemyer  |  

WASHINGTON D.C.—The Trump Administration is experimenting with several new primary care payment models, including one that would shift providers to global payments.

Called the Primary Cares initiative, the aim is to push primary care providers to take on more risk, officials said.

“This initiative will radically elevate the importance of primary care in American medicine, move toward a system where providers are paid for outcomes rather than procedures and free doctors to focus on the patients in front of them, rather than the paperwork we send them,” said Health and Human Services Secretary Alex Azar during an announcement at the American Medical Association on Monday,

Primary Cares includes two tracks—Primary Care First and Direct Contracting—that will offer providers varied degrees of risk-sharing to encourage population-based primary care. HHS officials estimate the voluntary models could cover a quarter of Medicare fee-for-service beneficiaries. The Centers for Medicare & Medicaid Services are intending to begin accepting application requests over the next several months and to launch the models in January 2020.

Launching the new models is a “historic turning point in American healthcare,” Azar said. Read the full article

Benefits of HBPC HBPC in the News HCCIntel Legislative News Press Releases

Primary Care First: Foster Independence, Reward Outcomes

Doctor talking to patient


Primary Care First is a set of voluntary five-year payment model options that reward value and quality by offering innovative payment model structures to support delivery of advanced primary care. In response to input from primary care clinician stakeholders, Primary Care First is based on the underlying principles of the existing CPC+ model design:  prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes.

Why develop a new model based on the underlying principles of the CPC+ model?
Primary care is central to a high-functioning healthcare system and thus, there is an urgent need to preserve and strengthen primary care as well as a need for support of serious illness care services for Medicare beneficiaries.

Primary Care First addresses these needs by creating a seamless continuum of care and accommodates a continuum of interested providers. The payment options test whether delivery of advanced primary care can reduce total cost of care, accommodating practices at multiple stages of readiness to assume accountability for patient outcomes. Primary Care First will focus on advanced primary care practices ready to assume financial risk in exchange for reduced administrative burdens and performance-based payments.

Thorough a second payment model option, Primary Care First also encourages advanced primary care practices, including providers whose clinicians are enrolled in Medicare who typically provide hospice or palliative care services, to take responsibility for high need, seriously ill beneficiaries who currently lack a primary care practitioner and/or effective care coordination—population groups referred to under the model as the Seriously Ill Population or SIP.

How does Primary Care First transform the health care system?

Primary Care First reflects a regionally-based, multi-payer approach to care delivery and payment. Primary Care First fosters practitioner independence by increasing flexibility for primary care, providing participating practitioners with the freedom to innovate their care delivery approach based on their unique patient population and resources.  Primary Care First rewards participants with additional revenue for taking on limited risk based on easily understood, actionable outcomes.

What are the model’s goals and how will the model achieve these goals?
Primary Care First aims to improve quality, improve patient experience of care, and reduce expenditures. The model will achieve these aims by increasing patient access to advanced primary care services, and has elements specifically designed to support practices caring for patients with complex chronic needs or serious illness. The specific approaches to care delivery will be determined by practice priorities. Practices will be incentivized to deliver patient-centered care that reduces acute hospital utilization. Primary Care First is oriented around comprehensive primary care functions: (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and (5) planned care and population health.

Primary Care First aims to be transparent, simple, and hold practitioners accountable by:

  • Providing payment to practices through a simple payment structure, including:
  1. a payment mechanism that allows care to be driven by clinicians rather than administrative requirements and revenue cycle management;
  2. a population-based payment to provide more flexibility in the provision of patient care along with a flat primary care visit fee; and
  3. a performance based adjustment providing an upside of up to 50% of revenue as well as a small downside (10% of revenue) incentive to reduce costs and improve quality, assessed and paid quarterly.
  • Providing practice participants with performance transparency, through practitioner-identifiable information on their own and other practice participants’ performance to enable and motivate continuous improvement.

Primary Care First provides the tools and incentives for practices to provide comprehensive and continuous care, with a goal of reducing patients’ complications and overutilization of higher cost settings, leading to higher quality of care and reduced spending.

How will beneficiaries and their families benefit from Primary Care First?

Primary Care First prioritizes patients by emphasizing the doctor-patient relationship. The model aims to improve the experience for beneficiaries by reducing administrative burdens so practitioners can spend more time with patients. The Centers for Medicare & Medicaid Services (CMS) will prioritize patient choice in the assignment of Medicare beneficiaries to Primary Care First practices. Read the full press release


Event Events HBPC in the News HCCIntel Legislative News

CMS to launch new direct-contracting pay models in 2020

Secretary Alex Azar

April 23, 2019  |  Susannah Luthi  |  Modern Healthcare

HHS on Monday launched an ambitious, double-pronged strategy to shift primary care from fee-for-service payments to a global fee model where clinicians and hospitals could assume varying amounts of risk.

HHS Secretary Alex Azar told a crowd of stakeholders at the American Medical Association in Washington that the CMS projects the new voluntary programs will shift at least a quarter of people in traditional Medicare out of fee-for-service.

The first model aims at small primary-care practices, offering two options with a flat monthly fee per patient. Bonuses or penalties will depend on their ability to keep their patients “healthy and at home,” said Adam Boehler, director of the CMS’ Center for Medicare and Medicaid Innovation, or CMMI.

Larger practices and health systems would have additional choices, which could be very lucrative but pose steeper risks. Under the first “professional option,” providers would assume 50% of the risk, including savings and losses. Under the “global option,” providers would take on full risk.

There is also a “geographic option,” in which health systems or insurance plans could assume the risk for the total cost of primary care for a swath of communities within a particular region.

Most of the newly announced Innovation Center models will launch in January 2020. The geographic option is projected to begin in mid-2020.

The administration officials painted the models as a sweeping overhaul of the fee-for-service model, even though the model is voluntary. Verma said the CMS hopes to incorporate state Medicaid programs as the policy rolls out across the country. Read the full article

Benefits of HBPC Event HBPC in the News HCCIntel Legislative News Practice Management

HHS To Deliver Value-Based Transformation in Primary Care

Doctor providing primary care in the home to a chronically ill patient


The CMS Primary Cares Initiative to Empower Patients and Providers to Drive Better Value and Results

Today, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma are announcing the CMS Primary Cares Initiative, a new set of payment models that will transform primary care to deliver better value for patients throughout the healthcare system. Building on the lessons learned from and experiences of the previous models, the CMS Primary Cares Initiative will reduce administrative burdens and empower primary care providers to spend more time caring for patients while reducing overall health care costs. The models were developed by the Innovation Center under the leadership of Adam Boehler and are part of Secretary Azar’s value-based transformation initiative.

“For years, policymakers have talked about building an American healthcare system that focuses on primary care, pays for value, and places the patient at the center. These new models represent the biggest step ever taken toward that vision,” said HHS Secretary Alex Azar. “Building on the experience of previous models and ideas of past administrations, these models will test out paying for health and outcomes rather than procedures on a much larger scale than ever before. These models can serve as an inflection point for value-based transformation of our healthcare system, and American patients and providers will be the first ones to benefit.”

Empirical evidence shows that strengthening primary care is associated with higher quality, better outcomes, and lower costs within and across major population subgroups. Despite this evidence, primary care spending accounts for a small portion of total cost of care, and is even lower for patients with complex, chronic conditions. Primary care clinicians serve on the front lines of the healthcare delivery system, furnishing services across a wide range of specialties, from family medicine to behavioral health to gerontology. For many patients, the primary care clinician is the first point of contact with the healthcare delivery system. CMS’s experience with innovative models, programs and demonstrations to date have shown that when incentives for primary care clinicians are aligned to reward the provision of high value care, the quality and cost effectiveness of patient care improves.

“As we seek to unleash innovation in our health care system, we recognize that the road to value must have as many lanes as possible,” said CMS Administrator Seema Verma. “Our Primary Cares Initiative is designed to give clinicians different options that advance our goal to deliver better care at a lower cost while allowing clinicians to focus on what they do best: treating patients.”

Administered through the CMS Innovation Center, the CMS Primary Cares Initiative will provide primary care practices and other providers with five new payment model options under two paths:

Primary Care First and Direct Contracting

The five payment model options are:

  1. Primary Care First (PCF)
  2. Primary Care First – High Need Populations
  3. Direct Contracting – Global
  4. Direct Contracting – Professional
  5. Direct Contracting – Geographic

The Primary Care First (PCF) payment model options will test whether financial risk and performance based payments that reward primary care practitioners and other clinicians for easily understood, actionable outcomes will reduce total Medicare expenditures, preserve or enhance quality of care, and improve patient health outcomes. PCF will provide payment to practices through a simplified total monthly payment that allows clinicians to focus on caring for patients rather than their revenue cycle. PCF also includes a payment model option that provides higher payments to practices that specialize in care for high need patients, including those with complex, chronic needs and seriously ill populations (SIP).

Both models under PCF incentivize providers to reduce hospital utilization and total cost of care by potentially significantly rewarding them through performance-based payment adjustments based on their performance.  These models seek to improve quality of care, specifically patients’ experiences of care and key outcome-based clinical quality measures, which may include controlling high blood pressure, managing diabetes mellitus, and screening for colorectal cancer. PCF will be tested for five years and is scheduled to begin in January 2020. A second application round is also planned for participants starting in January 2021.  Read the full press release

HCCIntel Legislative News

How New Payment Models, Big Data Are Disrupting Home Health Care

Data and payment model graphic


While technology behemoths and up-and-coming startups are often cited as the industry’s top disruptors, it’s innovative payment models and big data that will likely have the greatest impact on home health care delivery over the next several years, experts predict.

Additionally, as long as gaps exist throughout the hospital-to-home transition process, further disruption is sure to come from non-medical home care providers and entities operating on the fringes of the in-home care space.

“Somewhere between a $3,000 home health episode and going home with nothing, there’s a gap in care for people who might not need intense home health care, but need some support and assistance with the transition from hospital-to-home,” Tony D’Alonzo, director of clinical strategy and innovation for Bayada Home Health Care, said.

D’Alonzo highlighted macro-level trends and other factors disrupting the home health industry during an April 10 panel discussion at Home Health Care News’ Capital + Strategy Forum in Washington, D.C.

Rexanne Domico, president of home health care and rehabilitation services for BrightSpring Health Services, joined D’Alonzo on the panel. As did Dr. Roy Beveridge — who recently retired from his role as chief medical officer for insurance giant Humana Inc. (NYSE: HUM).

With more than 28,000 employees and 360 offices in nearly two dozen states, Moorestown, New Jersey-based Bayda is one of the largest home health providers in the country. In addition to its U.S. footprint, Bayada operates across six countries.  Read the full article


Benefits of HBPC Event HCCIntel Training

Visit HCCI at AGS19

AGS19 HCCI Booth invite

If you’re planning to attend the American Geriatrics Society 2019 Annual Scientific Meeting, May 2-4 in Portland, Oregon, make plans to stop by the Home Centered Care Institute (HCCI) exhibit booth #317.  Staff from HCCI will be on hand to answer your questions about home-based primary care (house calls) and why the future of health care is in the home.

We’ll have information about HCCI’s upcoming workshops, elearning modules, and consulting services.

If your existing HBPC practice is experiencing challenges, HCCI can help with a practice assessment, chart audits or onsite coaching.  If you’re interested in starting a house call practice, adding house calls to your existing office-based practice, or just learning about the growing field of house call medicine, HCCI offers an array of education and consulting services to help you attain your goals.

Learn more about AGS19 at

Benefits of HBPC HBPC in the News HCCIntel

Amazon Prepares to Strategically Disrupt Healthcare Market  |  Staff writer  |  April 10, 2019

Amazon has recently taken a series of significant steps to strategically position itself to disrupt the U.S. health sector.

The retail giant has a number of advantages that will accelerate its entry into the complex health market and potentially cause existing members of the sector to re-evaluate their core offerings.

U.S. healthcare is ripe for disruption. Drug prices and other costs remain high despite being a priority in Washington; intermediaries including pharmacy benefit managers, drug wholesalers, and distributors are driving up costs; and the industry is notorious for its waste and inefficiency. Most notably, healthcare has failed to keep pace with changing customer expectations, being neither responsive nor customer-focused.

In a detailed examination of Amazon’s health strategy, authors at CBInsights commented that “customer experience has been an afterthought in almost every part of healthcare, and is reflected in the poor NPS scores [Net Promoter Scores, which relate to customer satisfaction] across the board.”

Disrupting the Challenging Healthcare Market

Amazon CEO Jeff Bezos announced his intention to compete in healthcare while acknowledging the complexity of the challenge.

“[As hard] as it might be, reducing healthcare’s burden on the economy while improving outcomes for employees and their families would be worth the effort,” he said. “Success is going to require talented experts, a beginner’s mind, and a long-term orientation.”  Read the full article