AmeriHealth Caritas Louisiana Selected To Participate in Primary Care First

CMS model provides opportunity for collaboration on value-based care

December 3, 2020 - Baton Rouge, La.

AmeriHealth Caritas Louisiana, a Healthy Louisiana Medicaid managed care health plan and part of the AmeriHealth Caritas Family of Companies, has been chosen by the Centers for Medicare & Medicaid Services (CMS) to participate in Primary Care First (PCF), the third phase of CMS’ nationwide primary care payment redesign initiative. AmeriHealth Caritas Louisiana is one of only three Louisiana health plans (including Medicaid, Medicare, and commercial) selected to join the state’s Department of Health in this program.

PCF is a multi-payer model designed to provide primary care practices the tools and incentives they need to reduce patients’ complications and overutilization of higher cost settings, leading to improved outcomes and reduced spending. As a multi-payer model, PCF also provides an opportunity to collaborate with other payers on best practices around the advancement of value-based care.  

The program stands to benefit AmeriHealth Caritas Louisiana members who receive care at participating primary care practices by improving quality and patient experience through promotion of five comprehensive primary care functions:

  • Access and continuity
  • Care management
  • Comprehensiveness and coordination
  • Patient and caregiver engagement
  • Planned care and population health

As a health care payer, AmeriHealth Caritas Louisiana will implement a model that provides a payment structure designed to support CMS-selected primary care providers (PCPs) by reducing administrative burden, providing flexibility in the provision of patient care, and delivering performance-based incentive opportunities based on improved quality and efficiency performance. Participating AmeriHealth Caritas Louisiana network providers will also have access to dashboards that will offer real-time data insights for practices to manage their performance.

“Our plan’s participation in the PCF program is the most recent example of our dedication to payment and clinical transformation that prioritizes value, and demonstrates our continued commitment to improving health outcomes through innovative strategies,” said AmeriHealth Caritas Louisiana Market President Kyle Viator. “Primary care is critical to ensuring our members achieve the best outcomes. PCF will expand on our collaboration with providers to advance primary care and deliver access to quality care for members, with improved patient outcomes and total cost of care.”

AmeriHealth Caritas Louisiana’s participation in the PCF program is the next step of the plan’s ongoing movement toward value-based health care. The health plan currently participates in Comprehensive Primary Care Plus (CPC+), the second phase of CMS’ nationwide primary care payment redesign initiative. It also offers a comprehensive suite of value-based programs for providers across the health care continuum.

For questions about the PCF model or the application process, visit the CMS website, or email https://innovation.cms.gov/innovation-models/primary-care-first-model-options.