What is the MCP Model?
The Making Care Primary (MCP) Model is designed to improve care delivery for patients with chronic illnesses by incentivizing healthcare providers to focus on comprehensive, patient-centered care. It aligns with CMS’s goals of advancing health equity, reducing unnecessary costs, and promoting better health outcomes. By restructuring payment mechanisms, MCP encourages providers to invest in preventive care, care coordination, and innovative practices that enhance the quality of care.
Quality Measures: The Backbone of MCP
Quality measures serve as the foundation of accountability within the MCP model. These measures are critical in evaluating how well providers meet the program’s goals and ensure that patient care remains the central focus.
Focus on Chronic Conditions
The MCP model prioritizes quality measures that address prevalent chronic conditions such as diabetes, hypertension, and depression.
Tying Performance to Payments
Performance on quality measures directly impacts payment adjustments under the MCP model. Providers who excel in achieving high-quality care for their patients stand to gain financial incentives, whereas underperformance could lead to reduced payments. This approach reinforces the importance of accurate data reporting and continual improvement in care delivery.
How Providers Can Prepare for MCP
The emphasis on quality measures under MCP underscores the need for providers to enhance their data collection and reporting capabilities. Here are some actionable steps:
Invest in EHR Optimization Ensure that your EHR system supports the collection and reporting of eCQMs. Regularly update your software to align with CMS’s reporting requirements.
Train Your Team Educate clinical and administrative staff about the importance of quality measures and how to document patient care accurately.
Engage Patients Many quality measures, such as those related to screenings and chronic disease management, depend on patient participation. Focus on proactive communication and follow-up to ensure patients stay engaged in their care plans.
Monitor Performance Regularly Use dashboards or reporting tools to track your performance on key quality measures. Identify areas for improvement and implement targeted interventions to address gaps in care.
Performance Incentive Payment (PIP)
The Performance Incentive Payment (PIP) is an upside-only bonus opportunity designed to reward participants for improving the quality of care and preventing costly episodes where possible. The PIP is applied as a percentage adjustment to the sum of primary care fee-for-service (FFS) revenue and prospective primary care payment revenue. The details of the PIP opportunity vary by track:
PIP by Track:
Track 1: Potential to receive an upside-only PIP of up to 3% of the sum of FFS revenue.
Track 2: Potential to receive an upside-only PIP of up to 45% of the sum of FFS and prospective primary care payments (PPCP).
Track 3: Potential to receive an upside-only PIP of up to 60% of prospective primary care payments (PPCP).
Key Features of PIP:
A PIP is a percentage adjustment to a participant’s payment for primary care services, determined by performance on the MCP Performance Measure Set.
MCP participants must report all quality measures for their respective track to receive a PIP adjustment.
For Tracks 2 and 3, participants must also meet or exceed the 30th percentile nationally for Total Per Capita Cost (TPCC).
Continuous Improvement (CI) Measures evaluate participant performance against their own historical data, while other measures use a regional or national benchmark.
Quality Measures by Track
Track 1 Measures:
Controlling High Blood Pressure
Diabetes HbA1C Poor Control (>9%)
Colorectal Cancer Screening
Person-Centered Primary Care Measure (PCPCM)
Track 2 Measures:
Controlling High Blood Pressure
Diabetes HbA1C Poor Control (>9%)
Colorectal Cancer Screening
Person-Centered Primary Care Measure (PCPCM)
Screening for Depression and Follow-Up
Depression Remission within 12 months
Screening for Social Drivers of Health
Emergency Department Utilization (EDU)
Total Per Capita Cost (TPCC)
Continuous Improvement (CI):
TPCC CI (non-FQHCs and non-Indian Health Program participants)
EDU CI (FQHCs and IHP participants)
Track 3 Measures:
Controlling High Blood Pressure
Diabetes HbA1C Poor Control (>9%)
Colorectal Cancer Screening
Person-Centered Primary Care Measure (PCPCM)
Screening for Depression and Follow-Up
Depression Remission within 12 months
Screening for Social Drivers of Health
Emergency Department Utilization (EDU)
Total Per Capita Cost (TPCC)
Continuous Improvement (CI):
TPCC CI (non-FQHCs and non-Indian Health Program participants)
EDU CI (FQHCs and IHP participants)
Conclusion
The MCP model represents a paradigm shift in how healthcare is delivered and financed, with quality measures playing a central role in its implementation. By focusing on the accurate reporting and achievement of these measures, providers can improve patient outcomes, achieve greater efficiency, and ultimately succeed within the MCP framework. The inclusion of incentives like the Performance Incentive Payment (PIP) further motivates participants to prioritize high-quality care and cost management.
As providers navigate the complexities of MCP reporting, MDinteractive can assist with tracking and reporting MCP measures, ensuring compliance and maximizing performance incentives.
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