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A Deep Dive Into the Payment Structure of Making Care Primary (MCP)

October 30, 2023

As value-based care is starting to become the norm, risk-caring provider organizations face the complex challenge of aligning their practices and workflows to maximize quality care delivery. The Making Care Primary (MCP) program offers a unique solution to this conundrum, particularly through its diverse payment structures designed to incentivize both care quality and operational efficiency. This article aims to serve as a comprehensive guide for those who are considering participating in the MCP program. We will dissect the MCP Payment Structure, focusing on its six distinct payment types: Upfront Infrastructure Payment (UIP), Enhanced Services Performance Incentive Payment (ESP), Prospective Primary Care Payment (PPCP), Ambulatory Co-Management (ACM), and MCP E-Consult (MEC). Each section will provide a deep dive into what these payments are, their intended use cases, eligibility criteria, and how they can be leveraged to achieve care delivery and quality improvement goals. By the end of this article, you will have a nuanced understanding of how the MCP program's financial mechanisms can be a strategic asset in your organization's journey towards value-based care.

An Overview of the Payment Types by Enrollment Track

Upfront Infrastructure Payment (UIP)

In the world of healthcare, the adage "you have to spend money to make money" holds a particular resonance, especially for smaller organizations with limited resources. The Upfront Infrastructure Payment (UIP) serves as a financial lifeline for such organizations, offering start-up funding to eligible Track 1 participants within the MCP program. Unlike traditional funding mechanisms, UIP is designed to be optional and targeted, aiming to support investments in infrastructure and healthcare information technology capabilities.

The UIP is not merely a financial stopgap; it's a strategic investment. By offering a payment of up to $145,000 over two years, organizations can bolster their care delivery systems, invest in telehealth solutions, and even upgrade their electronic health record (EHR) systems. These investments are crucial for enhancing patient care and streamlining operations, ultimately leading to a more sustainable and efficient healthcare model.

Eligibility for UIP is stringent, ensuring that only organizations with a genuine need can access this funding. The payment aims to level the playing field, allowing smaller providers to compete with larger, more established organizations. By understanding the nuances of UIP, healthcare executives can make informed decisions on whether this payment type aligns with their organizational goals and resource capabilities.

Enhanced Services Payment (ESP)

Navigating the complexities of healthcare requires more than just medical expertise; it demands a robust framework for care management and patient navigation. The Enhanced Services Payment (ESP) serves this exact purpose, offering a non-visit-based per-beneficiary-per-month (PBPM) payment that is adjusted for the attributed population's risk level.

Unlike traditional fee-for-service models that incentivize quantity over quality, ESP is designed to reward care coordination and patient-centric services. The payment supports a range of services, from care management and patient navigation to social determinants of health. It's not just about treating illness; it's about managing health.

The ESP is risk-adjusted, meaning it takes into account the complexity and needs of the attributed patient population. This ensures that organizations serving higher-risk communities are adequately compensated, leveling the playing field and encouraging a focus on quality over volume.

Eligibility for ESP is broad, making it a versatile tool for various healthcare settings. However, understanding the intricacies of this payment type is crucial for healthcare executives. It allows for strategic planning around care delivery models, resource allocation, and even partnerships with community organizations.

Prospective Primary Care Payment (PPCP)

As practices start to shift from fee-for-service to value-based care, the Prospective Primary Care Payment (PPCP) serves as a transitional financial mechanism. Available for participants in Tracks 2 and 3 of the MCP program, this quarterly PBPM payment is designed to ease organizations into a population-based payment structure.

PPCP is not just a financial model; it's a strategy for sustainable healthcare. By offering a predictable revenue stream, it allows healthcare providers to focus less on the administrative burden of billing and more on delivering quality care. The payment is designed to support a wide range of primary care services, from preventive measures to chronic disease management.

The eligibility criteria for PPCP are tailored to ensure that it serves organizations ready to make the leap from volume-based to value-based care. It's particularly beneficial for organizations that have already invested in care coordination and are looking to further integrate their services.

Understanding PPCP is essential for healthcare executives contemplating a shift in their financial models. It offers a balanced approach, allowing organizations to gradually adapt without the financial shock that often accompanies such transitions.

Ambulatory Co-Management (ACM)

The need for seamless coordination between primary care and specialty services has never been more critical. MCP’s Ambulatory Co-Management (ACM) payment type within the MCP program addresses this gap, fostering a collaborative environment where multiple healthcare providers can co-manage patient care.

ACM is not just a payment; it's a catalyst for integrated care. By financially incentivizing co-management, it encourages primary care providers and specialists to work in tandem, sharing responsibilities and expertise. This collaborative approach not only enhances the quality of care but also optimizes resource utilization, reducing redundancies and streamlining operations.

Eligibility for ACM is designed to be inclusive, allowing a wide range of healthcare providers to participate. However, the payment type requires a commitment to collaboration, data sharing, and ongoing communication between involved parties. For healthcare executives, understanding ACM's intricacies can offer insights into how to build more cohesive and efficient care teams.

MCP E-Consult (MEC)

Digital transformation is reshaping healthcare, and the MCP E-Consult (MEC) payment type serves as a cornerstone for integrating technology into patient care. Part of the MCP program's Specialty Care Integration Strategy, MEC aims to facilitate quick and efficient consultations between primary care providers and specialists through electronic means.

MEC is more than just a financial incentive; it's a tool for enhancing patient outcomes. By enabling e-consultations, it reduces the need for physical referrals, thereby expediting the care process and improving access to specialized services. This is particularly beneficial in rural or underserved areas where specialist care may be limited.

Eligibility for MEC is broad but focused, targeting healthcare providers who are willing to embrace technology for better care coordination. For healthcare executives, understanding the nuances of MEC can provide a roadmap for how to effectively integrate digital tools into their care delivery models.

Conclusion

MCP offers a multifaceted financial framework that aligns closely with the evolving needs of healthcare provider organizations. As we've explored in depth, each payment type—UIP, ESP, PPCP, ACM, and MEC—serves a distinct purpose, targeting specific gaps in care delivery and operational efficiency. To learn more about how to succeed in the program or need assistance with the application process, explore our offering or fill out the form below 

The application window for joining the MCP program is rapidly closing, with a final deadline of November 30, 2023. If you're considering participation, it's imperative to submit your application by this date to secure your spot. Following your application, the CMS will provide a tailored report outlining membership details and associated costs, allowing you to fully understand the incredible opportunity at hand. Rest assured, if you change your mind, there is flexibility: you can withdraw your application without any penalties. The best part? The application process is swift, taking a mere 10 minutes of your time. Don't miss out on this extraordinary chance to potentially elevate your Medicare FFS revenues by a minimum of 30%, with additional performance bonuses boosting that figure up to a staggering 90%.

Ready to take the next step in optimizing your practice's revenue? Apply now.

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