What is CMS Primary Cares?

Today, CMS announced a new plan called CMS Primary Cares, which is a plan to reimburse physician practices based on value and outcomes. The goal is to give primary care practices financial incentives to keep patients healthy and out of the emergency department. In rewarding physicians for keeping patients healthy, they are encouraging the use of proven techniques and technologies to interact with patients.

As the cost of healthcare in America increases year over year, it’s more important now than ever to implement programs like CMS Primary Cares to drive improved outcomes.

It is estimated that the cost of medical services will increase 5.5% every year over the next eight years. By 2027, we will be spending nearly $6 trillion on healthcare.

What is CMS Primary Cares?

How technology plays a role

The good news is, the technology exists to allow the most critical component of healthcare to function efficiently. With the right incentives in place, primary care providers will play a critical role in correcting this course.

By using healthcare communication tools like OhMD to improve patient access to care, we can all play a role in keeping patients healthier and out of the hospital.

The CMS Primary Cares program provides two major reimbursement pathways for different types of physician practices.

Primary Care First

This reimbursement is designed for small physician practices. It will allow practices that keep patients healthy and out of the hospital to earn as much as 50% more revenue than they do today. That same practice would go at risk with their revenue by as much as 10% if they are not able to keep patients healthy.

With CMS Primary Cares, providers would be paid a monthly per-patient payment that would increase for more complex, chronic patients.

Learn more about Primary Care First here.

Direct Contracting

The Direct Contracting payments are designed to reward larger organizations for better managing their patient population. With three different payment pathways, Direct Contracting replaces what was originally called the Next Generation ACO. By incentivizing larger organizations to deliver better care both in-person, and remotely between visits, the goal is to have a substantial impact on patient health.

Next steps…

As CMS Primary Cares evolves over the coming weeks and months, we’ll begin to see refinement in the exact reimbursement mechanism. With a scheduled January 2020 launch, there’s a lot to do.

We’re excited to help practices communicate with patients between visits as these programs evolve.