CMS Pumps Brakes on Primary Care First Launch

When the Centers for Medicare & Medicaid Services (CMS) unveiled its new voluntary risk-based in-home primary care initiative in April, home health providers and advocates responded with cautious optimism.

For some, that optimism will now have to be put on hold.

Although CMS is now accepting applications to participate in its Primary Care First payment models, the agency has delayed an official launch until the start of 2021.


Initially, CMS had expected the models to go live on Jan. 1, 2020.

Broadly, Primary Care First is one of two main pathways in the overarching Primary Cares Initiative, another step in policymakers’ plans to empower patients, drive better outcomes and shift care into the home. The second pathway is the Direct Contracting option.

Combined, the Primary Care First and Direct Contracting pathways create five new, risk-based payment models.


While physicians largely serve as the quarterback of care under the different models of the Primary Cares Initiative, at-home care providers will likely play key partner roles in stabilizing and observing complex patient populations in the home.

Meanwhile, hospice and palliative care organizations can participate exclusively in the Seriously Ill Population payment option of Primary Care First, either directly or by partnering with a primary care practice.

“It can be expected that primary care practitioners in any of the five iterations of the demonstration project would embrace home health services and hospice care as vital partners in managing their patients’ care needs in the community, as well as in transition to home from an in-patient setting,” National Association for Home Care & Hospice (NAHC) President William A. Dombi previously told Home Health Care News.

LHC Group Inc. (Nasdaq) Chief Strategy and Innovation Officer Bruce Greenstein described the Primary Cares Initiative as “one of the most exciting announcements from CMS in a while” shortly after it was promoted.

“Why does this matter for us in the home care industry? We know if you look at national health care expenditures where the highest spending occurs, [it’s] in institutions — typically hospitals,” Greenstein told HHCN. “Overwhelmingly, hospitalizations are appropriate, but there’s still a lot of institutional uses of care that are inappropriate. That would be an unnecessary cost, and that’s where [we] as an industry come in.”

Despite enthusiasm from health care providers, CMS has yet to release important details about how the Primary Cares Initiative will actually work.

Consequently, industry advocates believe the delay on the Primary Care First pathway is appropriate.

“It would be a mistake to launch this in 2020, and it is certainly responsible to delay the demo by a year,” Edo Banach, president of the National Hospice and Palliative Care Organization (NHPCO), told HHCN sister site Hospice News. “I wouldn’t be surprised if it were delayed further given some of the implementation concerns.”

Additional reporting by Jim Parker

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