Evaluation of the Primary Care First Model

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.

Primary Care First is oriented around five comprehensive primary care functions:

• Access and continuity
• Care management
• Comprehensiveness and coordination
• Patient and caregiver engagement
• Planned care and population health

Primary Care First includes roughly 3,000 practices across 26 regions, participating in two cohorts. Additionally, 22 payers have elected to partner with CMS, and this partnership expands a Primary Care First-like payment model to other insured populations such as Medicare Advantage, Medicaid, and the commercially insured.

CMS has contracted with Mathematica to evaluate the Primary Care First model. Mathematica is assessing whether the model reduces hospitalizations and total Medicare expenditures for Medicare fee-for-service beneficiaries served by Primary Care First practices. Mathematica is also examining the changes these practices make to their care delivery and the model’s effects on other intermediate outcomes and quality-of-care measures. The evaluation of the Primary Care First model relies on a mixed-methods approach that uses primary and secondary data, including qualitative interviews with patients, primary care practitioners, practice staff, practices, and payers; Medicare claims data; model participation and payment data; and surveys.

Stay tuned for future results from the evaluation. Future reports will describe whether and how practice activities improve quality of care and lower acute hospitalizations and total cost of care for Medicare beneficiaries.