A group of seven hospice and senior care providers have formed Advanced Illness Partners (AIP), a joint venture partnership geared for participation in the direct contracting payment models from the Center for Medicare & Medicaid Innovation. Several of the models are slated to launch in April, with a geographic direct contracting option coming in 2022.
The partners in AIP include seven nonprofit organizations: Pure Healthcare, Geriatric Solutions, Hospice of the Valley (Ariz.), Hope Healthcare, Housecall Providers, Cornerstone Hospice, Nathan Adelson Hospice and Capital Caring Health. Pure Healthcare is a venture of Ohio’s Hospice, a group of 10 affiliated providers located throughout that state.
“We’re excited to participate in CMMI’s innovative program to bring advanced illness care upstream and serve patients with complex, chronic disease in the home setting for the long-term,” said Eric De Jonge, M.D., director of geriatrics at Capital Caring Health and chief medical officer for AIP. “As non-profit providers, our network allows us to remain community-based while also sharing best practices and economies of scale to invest in tools that help us improve care and lower costs of care for high-needs patients.”
Hospice and other post-acute providers nationwide are working to engage patients further upstream in the course of their illnesses. New avenues of reimbursement are driving service diversification throughout much of the industry, with hospices launching programs like palliative care, PACE, home health and others. This will continue to be a major trend during 2021.
The direct contracting options include three voluntary payment models that are designed to help the U.S. Centers for Medicare & Medicaid Services (CMS) and health care providers reduce the cost of care and improve quality. The three models include the professional, global and geographic options. The models adapt and integrate concepts from other programs such as Accountable Care Organizations, the Medicare Shared Savings Program, and Medicare Advantage, as well as strategies used in the private sector.
Under the direct contracting professional model, providers would accept the risk for 50% of shared savings or losses for all Medicare Part A or Part B services for patients that fit the program’s eligibility requirements. Organizations working in this model would receive a risk-adjusted monthly payment for primary care services equivalent to 7% of the total cost of care.
Within the global model, providers would also bear 100% of the risk associated with eligible patients. Contracted agencies would have to choose between a Total Care Capitation option or a Primary Care Capitation option. Similar to the professional direct contracting option, this would be a capitated, risk-adjusted monthly payment for enhanced primary care services equal to 7% of the total cost of care.
AIP is one of 51 direct contracting entities approved for participation by CMMI. Combined, the seven providers involved in AIP care for more than 60,000 patients annually.