Track 2 of the Making Care Primary Model: Integrating & Expanding Care Services

Track 2: Implementing Advanced Primary Care

CMS’ recently announced Making Care Primary (MCP) model advances the agency’s drive to shift from a fee-for-service model to a value-based care model.

The MCP model takes a tiered approach, with three tracks of participation. This progressive structure is intended to enhance coordination of care and unlock better health outcomes through improved data, tools, communication, and payment, eventually facilitating patient co-management between primary and specialty care.

As suggested in our blog post covering Track 1, even organizations that don’t plan to participate can stay at the forefront of value-based care by working toward the model’s objectives.

Here’s an overview of what Track 2 entails, and how selecting the right care management platform is integral to continued progression in meeting the MCP model’s goals and objectives.

What is Track 2 of the Making Care Primary Model?

While Track 1 centers on risk stratification and establishing care management workflows, Track 2 focuses on implementing more expansive advanced primary care. Track 2 focuses on taking the next steps to provide a more comprehensive, whole-person approach to primary care. Specifically, Track 2 encourages partnerships with care providers who can support preventive care and early identification of other conditions, as well as the incorporation of non-physical services for behavioral health.

Track 2 also includes the first financial step payers will take. Payment for primary care will shift to a 50/59 blend of prospective population-based payments and FFS payments, with CMS continuing to provide additional financial support at a lower level than it did in Track 1.

BONUS for payers in the MCP model program: Payers who participate in the MCP model will be able to earn increased financial rewards for proof of improved health outcomes.

The Four Care Requirements of Track 2

Track 2 includes the following requirements, which are geared toward expanding and integrating primary care services available to populations:

1. Partner with specialists, including behavioral health professionals. Primary care providers should strengthen connections with specialty care providers and increase their capacity to support the behavioral health needs of beneficiaries. This includes implementing eConsults, which CMS defines as “a form of interprofessional consultation where the specialist provides clinical guidance without seeing the patient face to face.”
2. Partner with social services providers. This entails implementing social service referral workflows, establishing partnerships with social service providers, and using a community health worker or equivalent staff to support high-need beneficiaries.
3. Implement care management services for episode and case management. Track 2 calls for participants to implement chronic and episodic care management, as well as chronic condition self-management support services. This is especially important for Medicaid and Medicare payers with a large percentage of members with chronic complex conditions or diseases, who need more preventive care and frequent outreach.
4. Screen for behavioral health conditions. Track 2 participants will need to implement a planned behavioral health integration approach and begin systematically screening members for behavioral health conditions including depression and substance use disorder. CMS clarifies that participants may also choose to screen for additional behavioral conditions that may impact health and wellness including

How Can Care Management Software Power MCP Track 2?

Track 2 is all about building partnerships to deliver well-coordinated, whole-person care that helps improve health outcomes and member well-being. Coordinate care depends on seamless communication and real-time, shared member data and insight among each care provider handling the member (primary care provider, specialist clinicians, behavioral health professionals, care managers, and community-based services, etc.).

It also requires an organized and more streamlined approach to case management, specifically with episodic and case-specific capabilities.

Payers on the MCP Track 2 will require a care management platform that:

• Can support case management.
• Provides configurable workflows.
• Provides a configurable rules engine.
• Can be customized to support each payer’s specific population health needs so that episodic and case management efforts are connected, collaborative, more efficient, and more effective.
• Data interoperability and uniformity will also be key as data is shared across providers. (A platform that can act as a single source of truth is even better, so each care professional can access the member’s information in one place for faster care delivery.) Effective sharing of data keeps everyone involved aligned on members’ health for greater continuity of care.)
• Offers built-in behavioral health assessments, workflows, and tools.

TIP: Selecting a solution that enables painless translation of data into formats that meet the HL7^® FHIR^® standard can make all the difference regarding speed, accuracy, and simplified data exchange.

Why Payers on the MCP Model Will Benefit from HELIOS

HELIOS is purpose-built for value-based whole-person care, and it’s already set up in the way Making Care Primary model participants will need. Below are some reasons HELIOS is a smart choice for MCP model healthcare payers.

1. HELIOS is nearly 90% configurable right out of the box and offers the most flexibility and configurability in the market. It’s also easy to scale for growing populations and changes in user base.
Organizations can use an impressive library of out-of-the-box workflows, assessments, risk triggers, and supported APIs, data integrations, and interfaces; AND HELIOS users can create and add their own.

2. HELIOS supports both case management and episodic care, including enabling seamless collaboration and connection with other providers across the care continuum, with programs and organizations in the community for services, and with configurable features that can help care teams automate tasks and support larger caseloads.

3. HELIOS is a leading solution to coordinate integrated behavioral concerns in diverse populations as well as to manage highly specialized cohorts. The platform includes powerful tools for assessing and addressing behavioral health ranging from counseling to addiction treatment to mental health issues. HELIOS offers out-of-the-box, industry-standard behavioral health assessments and screening tools that can help quickly identify patients who could benefit from receiving behavioral health services, as well as high-risk behaviors. Meanwhile, built-in behavioral health care pathways can align primary care offices with care management teams in guiding end-to-end care planning. HELIOS also supports alerts to high-risk behavioral health populations

4. HELIOS offers integrations with leading industry partners for social determinants of health (SDOH), and other critical areas that will help payers close care gaps and further MCP model care efforts.

Here are a few additional capabilities to look for when it comes to selecting a care management platform to help enable value-based care (that HELIOS already offers):

Digital health education content. Helping people understand how to self-manage their conditions is key for members with chronic disease. And when education resources are matched to literacy level and learning style, they’re even more effective. Care management platforms with integrated education resources help primary care providers get their patients the tailored information they need to encourage active participation in their healthcare.

Integration with RPM. Remote patient monitoring (RPM) devices (e.g., heart rate monitors, and glucose meters) are another great way that primary care providers can empower members to take control of their health. When RPM data integrates with a connected care management platform, care team members receive critical information on a member’s condition to guide timely intervention and care decisions, preventing unnecessary hospitalizations and emergency department visits.

Telehealth capabilities. The option for virtual telemedicine visits can help members keep up with appointments, especially during times when access and mobility are limited. If telehealth is a viable option for some visits, it can make life easier for members with chronic disease who have frequent appointments with a range of specialists. Similarly, the option to schedule a virtual behavioral health appointment through their primary care provider can make it more convenient for members to get the mental health support they need.

In-platform secure, digital communication and file exchange tools. Platforms with tools like SMS/text, email, and video chat can help primary care offices stay in touch with their patients, building trust and rapport. Mobile appointment scheduling and online portals that give members access to their health information also work to engage people in their health.

HELIOS by VirtualHealth supports all six of these critical value-based care efforts. Find out more by scheduling a quick call with our team to ask specific questions about how HELIOS could fit your population health needs.