Project Overview

Objective

To determine whether medical practices participating in the Primary Care First alternative payment model improve quality and reduce costs for Medicare fee-for-service beneficiaries.

Project Motivation

The Primary Care First model is a continuation of the Center for Medicare & Medicaid Innovation’s efforts to improve primary care in the United States and to shift from fee-for service to value-based payment.

Partners in Progress

  • Mission Analytics Group
  • Johns Hopkins University

Prepared For

U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation

Primary Care First is a voluntary, five-year, alternative payment model that rewards value and quality by offering an innovative payment structure to support the delivery of advanced primary care. Mathematica is independently evaluating the model’s implementation, impacts, and implications for future efforts to improve primary care.

Primary care is central to a high-functioning healthcare system. The Primary Care First model provides participating primary care practices with predictable population-based revenue and performance-based payments. The Centers for Medicare & Medicaid Services (CMS) hypothesizes that practices will use these payments to increase patients’ access to advanced primary care services. This, in turn, will lower hospitalization rates, improve quality of care, improve patient experiences of care, and reduce healthcare expenditures.

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Project Impact

Findings from the Third Annual Report

  • Primary Care First did not reduce acute hospitalization rates among Medicare fee-for-service beneficiaries in its first two years, and it increased Medicare expenditures by 1 percent.
  • Practices that initially joined in 2021 have remained engaged in the model and reported a range of changes to their delivery of care even if Primary Care First was not their main motivating factor or funding source.
  • Nearly two-thirds of practices pursuing care management strategies reported that changes were funded in part or solely by payments from Primary Care First.
  • Attrition from the model has been high. In the model’s first three years, 27 percent of practices left, primarily because of concerns related to financial aspects of the model. Broader multi-payer participation and alignment with the model was also limited.

Related Staff

Laura Blue

Laura Blue

Principal Researcher

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Leslie Conwell

Leslie Conwell

Principal Researcher

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Boyd Gilman

Boyd Gilman

Senior Fellow

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Karen  Bogen

Karen Bogen

Principal Survey Researcher

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John Schurrer

John Schurrer

Senior Researcher

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Brianna Sullivan

Brianna Sullivan

Survey Researcher

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Lauren Forrow

Lauren Forrow

Senior Statistician

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