CMS Announces Release of Primary Care First Seriously Ill Population Model Option

Categories: Policy.

Photo: HHS Secretary Alex Azar.

HHS Secretary Azar and the Center for Medicare & Medicaid Innovation announced the release of the Primary Care First Model Application. CMS states that this new alternative payment model will offer an innovative payment structure to support the delivery of advanced primary care.

Primary Care First is geared towards advanced primary care practices that are ready to accept financial risk in exchange for greater flexibility, increased transparency, and performance-based payments that reward participants for outcomes. Additionally, in Primary Care First, CMS will provide payments that are higher than historical Medicare fee-for-service (FFS) payments, in the aggregate, for participating practices that care for complex, chronically ill patients, and will enable participating practices to proactively engage seriously ill patients who exhibit “fragmented care patterns.”

Practices can choose from three participation options under Primary Care First:

  1. Practices choose to participate only in the PCF-General component of Primary Care First, and not in the SIP component, i.e. “PCF-General practices”;
  2. Practices choose to participate only in the SIP component of Primary Care First, and not in the PCF-General component, i.e. “SIP-only practices”;
  3. Practices choose to participate in both the SIP and PCF-General components of Primary Care First, i.e. “hybrid practices.”

Seriously Ill Population Option Participation:  CMS states that “people with serious illness often receive care that does not align with their preferences and goals under traditional FFS payment models, which can lead to fragmented, siloed care and poor care coordination, navigation difficulties, and at times, undesired or unnecessary treatments.  The objective of the SIP component is to identify seriously ill beneficiaries who are experiencing fragmented, uncoordinated care under Medicare FFS, deliver an intensive, episodic intervention to stabilize their clinical condition, and establish a meaningful relationship between the beneficiary and a practitioner who is accountable for coordinating and managing their care in the longer term.”


Members of the National Hospice and Palliative Care Organization will find a summary of eligibility requirements and payment and quality methodology, NHPCO members can access an NHPCO Policy Alert: Primary Care First Seriously Ill Population Model Option (10/24/19) that outlines key factors of importance for providers. (Member log-in is required.)

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