Making Care Primary Model Provider Update – July 3, 2023

Includes an overview of the newest Center for Medicare and Medicaid Innovation payment model for Medicare, NC Medicaid’s involvement and timelines.

On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new voluntary primary care payment model for Medicare called Making Care Primary (MCP) that will be tested in eight states, including North Carolina. CMS is offering this model for qualified Medicare providers in North Carolina beginning in July 2024. Medicare is a federal health insurance program for people age 65 or older, people under age 65 with certain disabilities and people with end-stage renal disease.

The MCP model will provide a pathway for primary care clinicians with varying levels of experience in value-based care to gradually adopt prospective, population-based payments, while building infrastructure to improve behavioral health and specialty integration and drive equitable access to care. The 10.5-year model will improve care management and care coordination, equip primary care clinicians with tools to form partnerships with health care specialists, and leverage community-based connections to address patients’ health needs as well as their health-related social needs (HRSNs) such as housing and nutrition.

CMS hopes to partner with commercial and public payers in the eight pilot states, including state Medicaid programs, to offer models for their members that are aligned to MCP. 

In choosing where to pilot this model, CMS considered geographic diversity, health equity opportunity, population, current CMS Innovation Center footprint and generalizability to the rest of the Medicare population for model evaluation. CMS’ selection of North Carolina as a Medicare pilot state for MCP is a recognition broadly of our innovations and leadership in primary care, care management and addressing health-related social needs, and the goals of MCP align closely with North Carolina Medicaid’s existing population health priorities.

Although the Medicare portion of the model will begin in 2024, other payers, including Medicaid agencies, have additional flexibility on if, and when, to launch an aligned approach. While NC Medicaid is continuing to learn about the details of MCP and has not yet committed to implementing an aligned model at this time, many of the goals of MCP are reflected in initiatives that NC Medicaid is currently engaged with, such as our workaround advanced medical homes, social determinants of health, streamlining of quality measures across payers, and the State Transformation Collaborative. As NC Medicaid considers whether to offer a model for NC Medicaid providers that aligns more specifically with MCP, we will engage a broad range of community partners, including providers and prepaid health plans, for feedback. 

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To be added to our communications list about MCP, please email and include “MCP” in the subject line.

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