Provider Insider

Value-Based Contracts

Fall 2019 | Issue No. 7

New payment models for primary care.

 

The Centers for Medicare and Medicaid Services Innovation Center (CMMI) recently announced two new voluntary primary care payment models: Primary Care First (PCF) and Direct Contracting. PCF is a program between your practice and CMMI (similar to CPC+). Direct Contracting is available for the Integrated Network, but is advanced beyond our current network capabilities. We want to make you aware of this value-based program in which you could participate individually, as UCHealth Integrated Network will not pursue the more advanced program at this time.

 

The new, five-year PCF model is designed for practices experienced with value-based payment arrangements that are ready to take on downside risk for Medicare fee-for-service patients in exchange for reduced administrative burden and performance-based payments. PCF has two payment types:

  • A risk-adjusted population-based payment (per-member-per-month).
  • A flat primary care visit fee.

Together, these payments make up the total primary care payment, which can be adjusted up to 50%, and a maximum downward adjustment of 10% dependent on performance.

 

CMMI announced two cohorts: non-CPC+ practices can apply in 2019 for a 2020 start date, and current CPC+ practices can apply in 2020 for a 2021 start date (exiting CPC+ one year early). Because PCF is expected to be an Advanced APM, non-CPC+ participants will be eligible for the 5% Advanced APM (AAPM) bonus for program years 2020–2022, and CPC+ participants who exit CPC+ and begin PCF in 2021 will be eligible for the AAPM bonus for program years 2021 and 2022. CMMI is expected to release the Request for Application this fall.

 

If you have any questions, please contact Dr. Austin Bailey or Paul Staley.