Medicare Enhanced Primary Care

Medicare Enhanced Primary Care (ECP) is one of the Centers for Medicare & Medicaid Services’ (CMS) Innovation Center models to test whether advanced primary care practices can improve health outcomes, decrease costs, and increase patient satisfaction. This voluntary model equips primary care clinicians with tools to form partnerships with health care specialists, address social determinants of health, and tap into community-based resources to reduce disparities in health.

In addition to introducing new payment innovations, ECP supports the use of data and technology to identify patients with unmet needs and provide targeted interventions. This supports a transition from fee-for-service payments to performance-based payments and will allow clinicians to identify patients with complex needs, screen for unmet social learn more below determinants of health, and link them to community-based support services.

EPC participants are also encouraged to engage with state Medicaid agencies to align their initiatives and promote greater collaboration. A key component of the model is to strengthen coordination between patients’ primary care clinicians, specialists, and community-based providers – ultimately leading to chronic disease prevention, fewer emergency room visits, and better health outcomes.

The model is designed to meet primary care organizations where they are, with three progressive tracks that recognize their varying experience in accountable care. Participating organizations will receive an upfront payment for their services to help ease the transition from fee-for-service, plus a risk-adjusted enhanced services payment that provides an additional investment in primary care. This will allow participants to expand their capacity for care management, including screening for unmet social determinants of health, to more fully connect their patients with behavioral health clinicians, and more.

Allied health rebates

If your doctor writes you an Enhanced Primary Care Plan (EPC) referral, you can access Medicare-subsidised allied healthcare appointments such as physiotherapy or podiatry. To be eligible, your GP must believe that you have a chronic medical condition and complex care needs. This can include diseases like asthma or diabetes, as well as musculoskeletal conditions. These allied health appointments are only available if your GP bulk bills and out of pocket expenses count towards the Medicare Safety Net.

The government’s initiative to help people with chronic medical conditions access allied health and dental care is making headway. A new scheme has been introduced allowing children and adolescents who are managed by their GP under an EPC plan to access Medicare-subsidised physiotherapy and podiatry treatments. This is a great initiative because it can help children and teenagers with chronic medical conditions and complex care needs get the help they need.

Medicare Enhanced Primary Care is the largest advanced primary care model that CMS has tested to date and will help ensure that we continue to offer the best quality of care for the most vulnerable members of our population. Read more about this model and stay tuned for future reports highlighting the results of the evaluation.

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