Primary Care Providers (PCPs) are the linchpin of the healthcare system, ensuring that patients receive holistic, coordinated, and continuous care. In the evolving healthcare landscape, PCPs are presented with various programs to align with. Two such programs that have garnered attention are Making Care Primary (MCP) and ACO REACH. While both have their merits, MCP emerges as a more favorable choice for PCPs, especially when considering risk structure, program flexibility, performance assessment, available tools, and program duration. In this article we will dive into the specifics of each of these areas, and why MCP stands out as the superior choice.

Upside Only Risk: Financial Safety First

MCP's "upside-only" risk structure is a significant attractor for PCPs. Unlike ACO REACH, which introduces both upside and downside risks, MCP allows providers to share in the savings without the potential for shared losses - providing the ability for a provider to advance from FFS to VBC without taking on any downside risk. This structure ensures that PCPs can innovate and enhance patient care without the financial strain or potential penalties. This applies to all 3 MCP participation tracks, whereas ACO REACH requires participants to take 50% shared losses to participate in advanced tracks. This can act as a deterrent for those who are interested in pursuing VBC, but aren’t comfortable with the associated downside risk. The MCP model encourages experimentation and improvement without the looming threat of financial repercussions - particularly in track 3 where they have the opportunity to earn incentive payments of up to 60% of their prospective primary care payments.

Program Flexibility: Welcoming All Experience Levels

MCP is uniquely tailored to accommodate both newcomers and seasoned veterans in value-based care. Whereas prior programs were targeted towards organizations who were already capable of delivering advanced primary care, MCP offers tracks for participants that are just beginning to develop the frameworks needed to deliver this type of care.The program provides a structured yet adaptable pathway, ensuring that all participants, regardless of their prior experience, can navigate the program with ease. ACO REACH, while comprehensive, might be more challenging for those unfamiliar with intricate value-based care models, making MCP's inclusive design a standout feature.

Individual Performance Recognition: Your Efforts Count

One of MCP's standout features is its individual performance assessment. Unlike ACO REACH, where performance metrics are pooled, MCP evaluates each provider's efforts separately. This ensures that high-performing providers aren't adversely affected by others' underperformance. It's a model that recognizes and rewards dedication and excellence, ensuring that providers are incentivized based on their individual contributions. For a deeper dive into the financial aspects of value-based care, check out our article on How to Use Analytics for Decision-Making in Value-Based Care.

Comprehensive Tools for Success

MCP stands out by offering a groundbreaking suite of tools, marking a first in advanced primary care models. Participating primary care organizations are directly equipped with resources that revolutionize care coordination with top-tier specialists. This includes:

• Data Dashboards: Access to real-time data dashboards allows providers to make informed decisions, ensuring that patient care is both timely and effective.
• Collaborative Care Arrangements: MCP fosters a collaborative environment, enabling seamless coordination between primary care providers and specialists. This ensures that patients receive comprehensive care without any gaps.
• Model-Specific Interprofessional Consultation: This feature allows for expert consultations within the model, ensuring that providers have the specialist insights they need to deliver optimal care.
• Time-Limited Co-Management Billing Privileges: A unique offering of MCP, these billing privileges ensure that the financial aspects of care are streamlined, reducing administrative burdens and ensuring that providers can focus on patient care.

In addition to these, MCP provides eligible track 1 participants an Upfront Infrastructure Payments (UIP), which consists of 2 annual payments of $72,500. This “use it or lose it” payment allows practices to build the infrastructure that help enhance patient care and outcomes. This includes investments in staffing, SDOH initiatives, or health IT systems designed to connect seamlessly with regional or national health information exchanges (HIEs) and service navigation tools. These tools play a pivotal role in coordinating both health-related and social support services, ensuring that patients receive a holistic care experience. While ACO REACH does offer tools, the comprehensive and innovative approach of MCP ensures that these tools are not just additions but integral parts of the care process, leading to more seamless integration into daily operations.

A Long-Term Commitment: Stability, Continuity, and Consistent Growth

The relatively short duration of ACO REACH raises significant concerns and uncertainties for providers contemplating a transition to value-based care. A limited timeframe of 4 years may not allow providers sufficient time to fully implement, refine, and realize the benefits of their value-based care strategies, potentially leading to suboptimal outcomes and diminished returns on investment. This constraint can create a pressured environment, where the focus may inadvertently shift from delivering high-quality, patient-centered care to rushing through the implementation of new practices to meet tight deadlinesMCP's 10.5-year duration underscores its commitment to fostering long-term care improvement. Unlike many programs that push providers into downside risk, MCP maintains an "upside-only" risk structure throughout its duration. This design choice offers several advantages:

• Consistent Financial Safety: Throughout the 10.5 years, providers can share in the savings generated without the looming threat of shared losses. This financial model ensures that providers can focus on innovating and enhancing patient care without the constant worry of potential financial repercussions.
• Phased Learning and Implementation: The extended timeframe is divided into four distinct tracks, each lasting 2.5 years. This structure allows providers to progressively deepen their expertise, refine their strategies, and expand their initiatives in a supportive environment. The continuity ensures that providers can build upon their successes, learn from challenges, and steadily improve care delivery.
• Encouraging Innovation: With the safety of upside-only risk, providers are more likely to experiment with new care models, technologies, and strategies. This environment fosters innovation, as providers aren't penalized for taking calculated risks to improve patient outcomes.

Conclusion

In conclusion, MCP's features, from its upside-only risk structure and program flexibility to its individual performance assessment, comprehensive toolset, and extended duration, make it a superior choice for PCPs. For those aiming to make a lasting impact in primary care while benefiting from a supportive and rewarding program, MCP is the clear frontrunner.

Interested in how our solutions can empower your practice? Explore Diagnostic Robotics' solution for providers that want to join Medicare's Making Care Primary Program.