October 30, 2019
On October 24, 2019, the Center for Medicare and Medicaid Innovation (CMMI) posted request for applications (RFAs) for the Primary Care First (PCF) and Kidney Care Choices (KCC) Models. The models were announced earlier in 2019. The applications are now available and are due by January 22, 2020.
Both are voluntary payment models that incentivize providers in the enhanced management and care of their patient populations and are expected to qualify as Alternative Advanced Payment Models (APMs) and/or Merit-based Incentive Payment System APMs in 2021 under the Quality Payment Program (QPP).
In addition to these two RFA, CMS is expected to release shortly an RFA for the Direct Contracting Model which was announced in April 2019.
Primary Care First (PCF) Model
The PCF Model aims to reduce Medicare spending on unnecessary inpatient hospital visits and improve the quality of and access to primary care by incentivizing care coordination and other advanced primary care functions. The model is designed for primary care practices with the ability to take on two-sided financial risk. Participants will receive a professional population-based payment; a flat primary care visit fee for each face-to-face encounter; and a quarterly performance-based payment adjustment. Participation in the model can theoretically increase payment by up to 50% or decrease it by up to 10%. The PCF Model will also have an optional component with a distinct payment model for practices that care for a seriously ill population (SIP).
This model is designed as a multi-payer model and CMS is seeking payer partners that can align with the PCF payment methodology, quality measurement strategy and data sharing approach.
The PCF Model will be tested over six years, with two staggered cohorts. The first cohort will participate from 2021-2025 and the second will run from 2022-2026.
CMS will be hosting two webinars to help interested parties navigate the PCF Model application process.
Primary Care First Application Webinar
Wednesday, October 30
3:00 PM (ET) – 4:00 PM (ET)
CMS Primary Care First Seriously Ill Population (SIP) Webinar
Thursday, October 31
12:00 PM (ET) – 1:00 PM (ET)
Kidney Care Choices (KCC) Model
The KCC Model is designed to provide financial incentives for providers to provide coordinated care for Medicare beneficiaries with late-stage chronic kidney disease and end-stage renal disease (ESRD) with the goal of delaying the need for dialysis and encouraging kidney transplantation. The KCC Model is expected to run from January 1, 2021 through December 31, 2023, with the option of an extension of one to two years.
KCC Model participation options:
The McDermottPlus CMMI Tracker is available here.
For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at firstname.lastname@example.org or Mara McDermott at email@example.com.