How to Get Started with the Making Care Primary Model

Track 1: Building the Infrastructure for Better Value-Based Primary Care

CMS recently announced its new Making Care Primary (MCP) model, a voluntary initiative set to launch in July 2024 among selected participants in eight states. As of September 2023: “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.” Source: CMS

Key Objectives of the MCP Model

  1. Continue paving the way for organizations to move from fee-for-service (FFS) payment to prospective, population-based payment.
  2. Strengthen primary care infrastructure to better integrate specialist and behavioral health care, as well as drive more equitable access to healthcare.
  3. Improve care management and care coordination.
  4. Better equip primary care clinicians to partner with health care specialists.
  5. More frequently and effectively leverage community-based connections and programs designed to address health and health-related social needs (such as critical social determinants of health (SDOH) including housing and nutrition).

Track 1: Laying the Foundation for Value-Based Primary Care

The MCP model comprises three separate tracks that guide participants along a progressive transformation to providing value-based care. According to CMS, Track 1 is designed for participants with no prior value-based care experience.

If you’re just getting started with value-based care, taking note of Track 1 goals can help guide key steps and measures to focus on.

Track 1 Goals and Performance Measures

Track 1 helps participants develop a foundation for shifting toward value-based primary care services through the following:

  • Data integration
  • Risk stratification of the patient population
  • Workflow development
  • Health-related social needs (HRSN) screenings and referrals
  • Chronic disease management

Meanwhile, Track 2 focuses on implementing advanced primary care, and Track 3 moves participants into optimizing care and partnerships.

CMS also has proposed performance measures across varying areas of focus to track success. Here are the ones specific to Track 1 participants:

  • Control of high blood pressure and diabetes (chronic conditions focus area)
  • Colorectal cancer screening (wellness and prevention focus area)
  • Person-Centered Primary Care Measure (person-centered care focus area)

Can the Right Care Management Solution Can Get You on Track for Value-Based Care?

Yes. The right care management platform can help healthcare payers meet key MCP Track 1 objectives and build a stronger foundation for value-based care delivery.

Here are five ways a care management platform can enable whole-person care, improve outcomes, and reduce healthcare overutilization and costs.

1. Data interoperability to power coordination and collaboration. A platform capable of helping payers to achieve healthcare interoperability and adopt FHIR® is critical. VirtualHealth just launched the first-ever FHIR® Integration Platform as a Service (FiPaaS) called HELIOShub. HELIOShub helps payers quickly and easily connect and transform all their critical data into formats that meet the HL7® FHIR® standard, without either specialization or heavy lifting by IT teams. It was designed intentionally with self-management in mind with configurable data transformations, mapping, and transfer methods that translate to faster delivery, rapid time to market, and reduced implementation and maintenance costs. [Learn more about HELIOShub here.]

2. Comprehensive member/patient views across the entire care continuum.
HELIOS collects data from multiple sources, giving all participants in an individual’s care, from primary care to clinical specialists to behavioral and social services providers, a complete, accurate, and real-time 360°-view of each patient. Working from the complete, real-time story of an individual’s health, including goals, up-to-date diagnoses and treatments, barriers, and progress notes, helps lead to more effective, coordinated care experiences and better health outcomes.

3. Population health management tools to support complex population health needs. A population health solution that provides comprehensive population analytics and reporting, population and cohort-level analysis capabilities, SDOH data and analysis integrations, smart target assessments for social and behavioral health, along with configurable, automated workflows, and advanced population stratification and risk scoring. Even better is choosing a platform that is NCQA prevalidated for population health management (like HELIOS).

[View some of the key features for population health in HELIOS including resources and tools for proactively identifying and addressing social determinants of health (SDOH).]

4. Automated workflows, diagnosis-based referral creation, and configurable assessments and risk triggers streamline and improve chronic disease management. Especially important for Medicaid and Medicare populations, such tools can help payers better manage and care for people with complex chronic conditions such as diabetes, or who have more complex health needs. In-platform referrals, the generation of assessments, automated task assignment and reminders, and clinical decision-making pathways that include evidence-based best practices are a few examples. Learn more here.

5. Built-in tools and support for health-related social needs. A care management platform can help primary care providers integrate more seamlessly with community partners – resulting in timely connection of patients with needed services that meet SDOH needs. A platform vendor that provides these within their solution is a valuable option for healthcare organizations of every size. See how FindHelp and VirtualHealth work together to help payers address critical SDOH needs.

Medicare care management best practices white paper

Making Care Primary Goals: Take Note

While it’s true that this new model will affect select Medicaid populations for now, it’s a strong indicator of CMS’ continued focus on a collaborative care management approach as a central driver of value-based care (value-based care). Consider some of the key goals of MCP and how they align with efforts that are foundational to delivering value-based care:

To enable comprehensive primary care that’s tightly coordinated with all specialists involved in an individual’s healthcare (including clinical, behavioral health, and social service providers), thereby improving quality and population health outcomes

To prioritize preventive care that helps patients avoid costly outcomes like developing chronic disease, emergency department (ED) visits, and re-hospitalizations

To enhance the ability of primary care providers to support patients’ unmet social and non-clinical needs that impact health (i.e., social determinants of health, or SDOH)

As CMS sums up in its Request for Applications, the model’s care delivery design is intended to help participants deliver equitable, team-based care and improve outcomes over time on key metrics like hypertension and diabetes control, depression, ED visits, and total cost of care.

Get on track for value-based primary care with HELIOS° by VirtualHealth.


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