The Centers for Medicare & Medicaid Services (CMS) announced five new, voluntary value-based payment models for primary care: Primary Care First and Direct Contracting. Applications are expected to open shortly, and both models will begin in January 2020 for five years. Both are expected to qualify as advanced alternative payment models (APMs). Included in the announcement was a request for information regarding a geographic risk model, where participants would assume financial and clinical accountability for a broader patient population.
The Primary Care First (PCF) path includes two voluntary, five-year payment models designed for small practices and provides a monthly population-based payment, flat primary care visit fee, and a performance-based payment adjustment to incentivize reduced hospital use. The is a second payment track under this model that will focus on seriously ill patient populations.
The Direct Contracting path is geared toward larger organizations with at least 5,000 Medicare beneficiaries that have experience taking on financial risk. There are three variations of the Direct Contracting model with increasing levels of risk-sharing and reward.
The U.S. Department of Health and Human Services (HHS) expects the models to create new opportunities for providers to coordinate care for a large share of the nearly 12 million beneficiaries who are dually eligible for Medicare and Medicaid, particularly for beneficiaries enrolled in Medicaid managed care and Medicare FFS plans.
Notably, the models build on recent changes made to the Medicare Shared Savings Program (MSSP). Many of the critical elements of the new models—prospective, population-based payments; streamlined quality metrics; etc. could address challenges associated with earlier iterations of Medicare's primary care and ACO models. However, the precise details of the payment mechanisms, financial model, and quality reporting requirements have yet to be released. We anticipate further information in the coming weeks.
CMS will host webinars on the following dates for interested stakeholders:
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