CMS Primary Cares: Five Steps to Assess Your Readiness

Dennis Butts, HealthLeaders

Despite the benefits of primary care, there are some important steps healthcare incumbents should take in deciding whether and how to participate.

Organizations that are eligible to participate in the new CMS Primary Cares Initiative models have a big determination to make: whether now is the right time.

Investments in primary care have been shown to improve health outcomes, but primary care services have represented less than 5% of Medicare fee-for-service spending, according to a recent RAND study.

Despite the established benefits of primary care and the promising signs around the CMS Primary Cares Initiative, there are some important steps for health systems, provider groups, and other incumbents to take in deciding whether and how to participate:

1. Evaluate your existing contracts.

If you are currently participating in the Medicare Shared Savings Program or another model, consider whether that is the best way to monetize the value you bring, says Dennis K. Butts, Jr., MBA, a managing director in Guidehouse's value transformation practice. A study by Guidehouse last year found that many ACOs are losing money. But your decision on whether to move to a Primary Care First (PCF) or Direct Contracting (DC) model depends on how it compares to what you have.

2. Assess your infrastructure.

Whether you have a long list of existing value-based contracts or not, you should ask yourself if you have made the necessary investments (or can muster the resources and will to make the investments in the near term) to support a value-based primary care undertaking, says Norman H. Chenven, MD, founding CEO for the Texas-based organization and vice chairman of the Council of Accountable Physician Practices. In addition to needing capacity for enhanced healthcare services and a powerful electronic health record system, you will need leaders in place at both the executive and physician levels, he says.

3. Gauge your PCP alignment.

Your primary care physicians and other groups may soon have new partnership opportunities, so don't take them for granted, Butts says. Be sure to engage them up front and bring them into conversations about the strategy, he adds.

4. Define a comprehensive strategy.

This value-based primary care initiative will be just one piece of each participating organization's Medicare business, so you should think of it in terms of a spectrum that includes fee-for-service, Medicare Advantage beneficiaries, and others, Butts says. Focus your energy on "no-regrets" strategies that will benefit Medicare beneficiaries across all those contracting vehicles, he says.

5. Embrace your tech-driven potential.

That may mean embracing a partner's technological expertise. If another organization can build a better app than you or facilitate telemedicine more effectively, don't be too quick to think of them purely as a competitor, Butts says.

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