Healthcare Snapshot

June 2023

CMMI Releases new Making Care

Primary (MCP) Model for 2024

CMMI recently released a brand-new model called Making Care Primary (MCP). This new model will be a 10-year test and is set to begin on July 1st, 2024. The focus will be to bring upfront funding to Primary Care Practices to help drive care transformation in 8 states: Washington, Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, and Massachusetts.

MCP will be split into 3 different participation tracks designed for providers with varying levels of experience in Value-Based Care. Track 1 provides upfront infrastructure payments to participants and providers who will continue to bill Fee-for-Service (FFS). Track 2 is a blended payment structure of 50% FFS and 50% prospective population-based payments. Track 3 will be built upon 100% prospective population-based payments. Each of these tracks will also include financial rewards from CMS to drive performance and transformation.

Here are a few key details of what we know right now:

1. Federally Qualified Health Centers (FQHCs), Indian Health Service (IHS) clinics, and smaller underserved rural practices will be able to participate in MCP. 
2. Rural Health Clinics (RHCs), Concierge practices, and current ACO REACH participants are not eligible to participate in the model. 
3. Current MSSP participants can only participate in both MSSP and MCP in 2024 in the last 6 months of 2024.
4. Participants must be Medicare-enrolled, located in one of the chosen states, and bill for health services to a minimum of 125 Medicare beneficiaries.
5. MCP will include health equity elements that continue to drive the administration’s commitment to health equity.

PSW will follow this model as more details are released and evaluate the opportunity for our partners.

Click here to find the official press release: CMS Announces Multi-State Initiative to Strengthen Primary Care.

The changing landscape of healthcare demands organizations have a robust compliance program that not only protects the company but effectively meets the increasing scrutiny of third parties. Compliance department oversight is vast and includes the following key areas:

1. Enterprise risk mitigation 

2. Policies and procedures

3. CMS/CMMI/Third party audit preparation

4. Develop internal auditing and monitoring plans and programs

5. HIPAA privacy and security services

6. Education, training and tools

Sara Aukerman, CPC, CPCO, serves as Compliance Officer for PSW, NW Momentum Health Partners ACO and MultiCare Connected Care. She is responsible for leading internal processes for ensuring compliance with federal and state regulatory requirements, prevention, identification, and remediation of compliance concerns (including fraud, waste, and abuse), direction of HIPAA privacy and security regulations, policies and contract development and execution. She is also responsible for creating and implementing policies and procedures, while ensuring they are communicated and trained upon across the organization.

Over her 14 years with PSW, Sara has had the opportunity to work in multiple departments and business lines, leveraging her extensive experience to provide compliance oversight for the varying lines of business as PSW grows.  

Does your company have a need for compliance consulting or services? If so, please feel free to reach out to communications@pswipa.com.

A patient with a new diagnosis of Congestive Heart Failure (CHF) was offered PSW's Care Management Services. She was in a state of confusion and overwhelmed by her many appointments. The patient was interested in Care Management Services but was hesitant to participate due to being scammed in the past.  

PSW's Nurse Care Manager notified her primary care provider that his patient was offered enrollment and was hesitant. The practitioner contacted the patient and encouraged her to participate. The practitioner confirmed that they worked with PSW and described that it would be beneficial to the patient. 

Since joining, the patient has worked towards learning how to self-manage her condition. She is weighing herself daily, taking her blood pressure medication and now uses a stoplight tool that helps her identify the warning signs for when she needs to contact her practitioner. She has received support to address her social needs such as meal support. She utilizers a team-based binder to help her keep her health information together and support communication between her all of her practitioners. She is successfully meeting her goals of regular exercise through walking, and gardening and returning to work.

Reps. Bera and Buchson are circulating a "Dear Colleague" letter to garner support for Medicare Access and CHIP Reauthorization Act (MACRA) reform. The letter calls for the need of a stable payment mechanism that appropriately pays for health outcomes.

This "Dear Colleague" letter has circulated to ACOs across the country so that it may be shared with representatives by entities that are local in their communities. Reps. Bera and Buchson are asking their colleagues to join them by signing onto a MACRA reform letter addressed to Speaker McCarthy and Leader Jefferies. The letter describes the challenges that MACRA has faced since its implementation in 2015 and the need for support to continue shifting the healthcare system from volume to value.

PSW has already begun circulating this letter with our representatives and have received support from many in Washington State who intend to join the letter. Representatives have until July 12th to join.

View the letter addressed to Speaker McCarthy and Leader Jefferies by clicking here.