Primary Care First is a five-year payment model established by the Centers for Medicare and Medicaid Services that rewards practitioners for providing higher quality primary care to Medicare and Medicaid beneficiaries. The goal of these financial rewards is to reduce the costs and use of resources for hospitals by encouraging primary care practitioners to offer more preventative services. These services can help patients avoid emergency room visits and even repeat, high-cost healthcare services such as surgeries for the same chronic illness more than once.

Where Is Primary Care First Offered?

Primary Care First is offered in 26 regions across the United States including these entire states:

• Alaska
• Arkansas
• California
• Hawaii
• Louisiana
• Maine
• Massachusetts
• Michigan
• Montana
• Nebraska
• New Hampshire
• New Jersey
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Rhode Island
• Tennessee
• Virginia

According to CMS, there are approximately 2,600 practices participating in Primary Care First. To join Primary Care First, practices can apply as long as they meet the eligibility requirements laid out by CMS.

Why Practices Should Join Primary Care First

Primary Care First does not just benefit patients. Practitioners who implement Primary Care First are incentivized financially through CMS to encourage higher quality care for patients. Practices are financially rewarded when the quality of healthcare practitioners provide reduces the cost of services that a patient needs. They are also financially rewarded to help hospitals reduce high costs, such as emergency room visits, that could be avoided with more intensive primary care and preventative screenings.

Normally, practitioners earn based on services they provide. This means that the more services they provide, the more they earn. However, this could be detrimental to the quality of care a patient receives, as practitioners feel more encouraged to push their high-cost services to earn more money. Through Primary Care First, CMS helps eliminate this problem. Instead of being paid for the number of services they provide, CMS make practitioners liable for the quality of the care they provide. Through high quality care, practices are financially rewarded. This can also help them reduce the costs of using resources that expensive care services require.

Tools for Providing Higher Quality Care 

Practices can utilize data tools to help them streamline the quality of care they provide to Medicare and Medicaid patients. These tools help practitioners assess the costs of the services they provide, patient outcomes, and identify areas of improvement within their care system. Using analytics tools helps practitioners optimize their workflow to achieve the greatest benefits possible from implementing a Primary Care First model.

Through a PCF model, practices can see increases in profitability while patients receive higher quality care that helps them save on potential future healthcare costs.

Primary Care First Payment Model

As opposed to a single bill for each service provided to a patient, payments could be broken up into regular monthly payments. This helps reduce administrative paperwork for care practitioners. For small practices, they could save a significant amount of time and administrative resources. In addition, revenue from Medicare patients becomes more predictable through PCF due to these regular payments.