Evaluation of the Primary Care First Model: Second Annual Report

Evaluation of the Primary Care First Model: Second Annual Report

Published: Feb 26, 2024
Publisher: Mathematica
Associated Project

Evaluation of the Primary Care First Model

Time frame: 2019-2028

Prepared for:

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

Clients
Mathematica | Progress Together.
Key Findings
  • Practices used model funds to make care delivery changes, including continuing ones they started prior to joining the model, that they believe will ultimately reduce hospitalizations.
  • Prior primary care transformation experience and affiliation with larger health care organizations facilitated these changes.
  • PCF payments were larger than Medicare FFS payments on average, but many practices felt payments were inadequate.
  • Risk group 1 and 2 practices focused on changes to care management strategies and practices in risk groups 3 and 4 took a broader approach to care delivery changes.
  • As expected this early in the model, PCF had minimal effects on hospitalizations and Medicare expenditures.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center launched the Primary Care First (PCF) model in 2021 to continue efforts from previous models that aim to advance primary care in the United States. The goals of PCF are to improve quality of care, improve patients’ experience of care, and reduce expenditures by increasing patients’ access to advanced primary care services through a simplified payment structure designed to reduce administrative burden and reward performance. A second cohort of practices joined in 2022.

Mathematica’s independent evaluation of PCF aims to determine whether the model meets these goals. In this second annual report, the evaluation team analyzes the implementation experiences of Cohort 1 and Cohort 2 practices and other payers participating in the PCF model and estimates the preliminary impact of the PCF model on acute hospitalizations and Medicare Part A and B expenditures relative to a comparison group. We also estimate impacts on a set of seven leading indicators identified to provide an early signal of whether care delivery changes are resulting in meaningful early outcome changes as well as a set of secondary outcomes that PCF is hypothesized to affect.

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