HHS To Deliver Value-Based Transformation in Primary Care | CMS

HHS To Deliver Value-Based Transformation in Primary Care

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

Medicare and CMS have been emphasizing their role in revising our health system to advantage primary care, and to increase reimbursement to primary care physicians.  The health care reimbursement system heavily favors specialists whose fees are heavily weighted for procedures. In the past family physicians, some internists, and pediatricians have been at the bottom of the pay scale.

In the past several years this has improved. The statistics just released in early 2019 reflect the improvement .


“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 the 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 the 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.

Base upon maximizing the value of health care, HHS has proposed the following new categories of payment using several new criteria.

Primary Care First and Direct Contracting.

The five payment model options are:

Primary Care First (PCF)
Primary Care First – High Need Populations
Direct Contracting – Global
Direct Contracting – Professional
Direct Contracting – Geographic

Readers should refer to these details for each category


















HHS NEWS: HHS To Deliver Value-Based Transformation in Primary Care | CMS: HHS To Deliver Value-Based Transformation in Primary CareThe CMS Primary Cares Initiative to Empower Patients and Providers to Drive Better Value and Results