The Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (Innovation Center) announced two new pathways encompassing five new payment models intended to move organizations toward value based payments and away from fee-for-service.
The first pathway, Primary Care First (PCF), builds on the existing Comprehensive Primary Care Plus experience and is aimed at smaller practices who would receive capitated payments and have incentives to care for complex chronically ill patients. The PCF has two tracks, a general track and a high need population track, also referred to as the Seriously Ill Population.
The second pathway, the Direct Contracting models, builds on the Medicare Shared Savings Program and Next Generation Accountable Care Organizations. This pathway targets larger organizations interested in participating in increased levels of two-sided risk sharing. The pathway includes three tracks: (1) a “Professional” track with 50 percent savings and losses and a primary care capitated payment arrangement for enhanced primary care services; (2) a “Global” track with 100 percent savings and losses and two payment options, primary care capitation or total care capitation; and (3) a “Geographic” track which will require participants to bear 100 percent risk for aligned beneficiaries in a targeted geographic region. CMS has released a request for information relating to the geographic track with comments due May 23, 2019.
The Innovation Center plans to release additional materials in the weeks to come that will contain more details about these models. The agency plans to release letters of intent in spring 2019 and requests for applications in summer or fall 2019. 2020 will serve as a beneficiary alignment year, and performance periods will begin in January 2021. The models are expected to run for five years.
Primary Care First Fact Sheet is available here; the Primary Care First model webpage is available here.
The Direct Contracting Fact Sheet is available here; the Direct Contracting Model webpage is available here.
For more information visit the McDermottPlus Payment Innovation Resource Center or contact Mara McDermott at email@example.com.