On April 22nd, the Centers for Medicare and Medicaid Innovation (CMMI) released a set of five new payment models. The expectation of these models is to transform payment for 25% of Medicare primary care physicians by providing new opportunities to use value-based purchasing in Medicare, and by better aligning the original FFS Medicare program with Medicare Advantage and dual-eligibles in Medicaid Managed Care.
The CMS Primary Cares Initiative will provide two paths: Primary Care First (PCF) and Direct Contracting (DC). PCF will consist of two options that focus on advanced primary care practices with varying levels of risk and employ performance-based payment adjustments. DC will consist of three voluntary, capitated risk-sharing model options with simplified quality metrics and reporting requirements, and wider eligibility than current risk-bearing ACO models.
The attached document summarizes key elements known to date of each payment model, with more information to come when the Request for Applications is issued. A non-binding Letter of Intent is required to participate. Additional information on Primary Care First is available here. More information on Direct Contracting is available here.