Updates to Medicare Value-Based Care Programs

The Center for Medicare and Medicaid Innovation recently announced updates to various value-based care programs. Important changes or delays that may impact your strategic planning are summarized below.

Primary Care First Model

The Centers for Medicare and Medicaid Services (CMS) Primary Care First (PCF) Model for Cohort 2 will accept applications for participation beginning January 2022 until the following dates:

  • April 30, 2021, for practices
  • May 28, 2021, for payers

The PCF model is designed to test if payments for advanced primary care that move away from a fee-for-service to a value-based payment approach have a positive impact on quality of care and reduce Medicare patients’ total expenditures. Estimated advanced payments range from $49 per-beneficiary-per-month (PBPM) to $212 PBPM, depending on the risk scores of the attributed lives.

PCF is available in 26 regions. There are currently 847 practices participating in the model and 14 payer partners. To be eligible for Cohort 2, a practice must serve at least 125 Medicare patients at a particular location, and at least 50% of the practice’s collective revenue must come from primary care services. Additional criteria is described in the Request for Application (RFA).

The Seriously Ill Population component of PCF is currently under review. It won’t begin on the previously announced start date of April 1, 2021.

Medicare Shared Savings Program

The Medicare Shared Savings Program (MSSP) has updated their Application Types and Timeline page related to the 2022 cohort. The key dates for the application or renewal process are listed below. All dates occur in 2021.

  • June 1–7: Submit Notice of Intent to Apply (NOIA)
  • June 28: Submit Phase 1 of application
  • August 3: Request for Information (RFI) 1—deadline to add participant taxpayer identification numbers (TINs)
  • Sept 10: RFI 2—deadline to remove participant TINs
  • Oct 12: Participant list dispositions—approval of each participant TIN
  • Oct 19: Submit Phase 2 of application
  • Nov 9: RFI for Phase 2
  • Dec 6: Complete e-signature process

Global and Professional Direct Contracting Model

The Global and Professional Direct Contracting Model’s 2021 program-year 1 participation agreement and benchmarks are available for participants starting April 1, 2021. Fifty-one organizations are currently participating in the implementation period, and program-year 1 participants are expected to be announced shortly.

An application period for the 2022 program-year 2 cohort is expected later this year.

Geographic Direct Contracting Model

The Geographic Direct Contracting Model will be tested over a six-year period in four to 10 metro-regions. It will test a geographic approach to value-based payments by assigning every Medicare fee-for-service (FFS) life located in a selected metro-region to a Direct Contracting Entity.

The application period was initially slated for March 1 to April 2, 2021, however, CMS announced that the application will be delayed until further notice. For more information, read our article.

Emergency Triage, Treat, and Transport Model

CMS has announced a Notice of Funding Opportunity for the Emergency Triage, Treat and Transport Model (ET3). CMS will award up to 40 two-year cooperative agreements to state and local governments, their designees, or other entities that operate or have authority over a public-safety answering point, such as a 911 call center.

The program is intended to establish or expand medical triage lines to increase efficiency and reduce improper use of emergency medical and ambulance services by directing patients to community resources and alternative services.

Applicants must be located in an area where at least one of the 185 ambulance providers currently participating in ET3 exist. Applications are due May 11, 2021, for a performance period beginning on September 10, 2021.

CHART Model Community Transformation Track

CMS will extend the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track application deadline to May 11, 2021. The Community Transformation Track will provide upfront funding to up to 15 rural communities across the country. The funding is intended to allow providers and payers to design systems of care to improve access to high-quality care that’s sustainable and value-based.

CMS will be accepting optional letters of intent (LOIs) for the CHART Model Community Transformation Track until April 13, 2021. All LOIs can be emailed to Interested applicants should include the following in their LOIs:

  • An expression of interest
  • Brief description of the interested organization
  • Preliminary list of the rural counties or census tracts that may define the community
  • Contact information, including the organization’s street address and a contact person’s name, position, email, and phone number (see NOFO Section C.3 Letter of Intent for more details)

An RFA for the Accountable Care Organization (ACO) Transformation Track is forthcoming in spring 2021. For more information about the CHART Model, read our article.

Kidney Care Choices Model

The Kidney Care Choices (KCC) Model builds upon the Comprehensive End Stage Renal Disease (ESRD) Care Model, which included 33 participants and concluded on December 31, 2020. This model adds financial incentives for health-care providers to manage the care for Medicare beneficiaries with chronic kidney disease at stages 4 and 5 ESRD. The goals of this model are to delay the use of dialysis and encourage kidney transplantation by preventing disease progression as well as increasing education and understanding of the kidney-disease process.

KCC has been delayed and will now start on January 1, 2022.

We’re Here to Help

Transitioning from fee-for-service to value-based care is one of Medicare’s top priorities and should be a strategic consideration for health care providers of all sizes. For help understanding the options that are available and support selecting the most appropriate model for your organization, contact your Moss Adams professional.

Special thanks to Danni Noonan staff, Health Care Consulting Practice, for her assistance with this article.

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