The Centers for Medicare & Medicaid Innovation (CMMI) has unveiled a new primary care-oriented Accountable Care Organization (ACO) payment model that holds opportunities for hospices.
This demonstration reflects a push by the U.S. Centers for Medicare & Medicaid Services (CMS) to reduce fragmentation in the health care system by strengthening primary care as a hub for patients’ treatments and services.
Though the model is focused on primary care, it could help more patients receive hospice and palliative care when appropriate, according to CMS.
“The CMS Innovation Center understands that palliative and hospice care are critical to a patient’s care journey, and we anticipate that the ACO PC Flex model’s focus on primary care will help increase access to palliative care and hospice for individuals with Medicare,” a CMS spokesperson told Hospice News in an email. “The model’s goal is to increase funding for primary care delivered by low-revenue ACOs in the [Medicare] Shared Savings Program so that they can provide advanced primary care, improve people’s experience and outcomes, and save on unnecessary health care spending.”
Historically, low-revenue ACOs have generated more savings and more extensively improved quality than their larger counterparts, according to CMS.
Through the model, participating ACOs will receive a one-time advanced shared savings payment of $250,000, as well as a monthly Prospective Primary Care Payments (PPCPs), designed to provide flexibility to coordinate primary care delivery and enhance coordination with specialists, the spokesperson said.
The PPCPs will also provide funds for care management, patient navigation, behavioral health integration and other care coordination services. The advance payments are also designed to help cover some of the costs of forming an ACO when appropriate, as well as administrative costs associated with the model.
ACOs will then distribute payment to the participating primary care providers in their networks.
The voluntary five-year model will launch on Jan. 1, 2025, with the application period starting May 20 and ending June 17. If they are not already participating, organizations will also have to apply to the Medicare Shared Savings Program.
CMS plans to select close to 130 ACOs for the program.
The model incorporates several elements that traditionally have been hallmarks of palliative care, including chronic disease management, team-based care, services delivered in the home and programs to address patients’ social needs. Other components of the model are designed to improve health equity.
“People whose primary care provider participates in the ACO PC Flex Model may get care in more convenient ways, like care based at home or through virtual means, extra help managing chronic diseases and more preventive health services to keep them healthy,” said CMS Administrator Chiquita Brooks-LaSure, in a statement. “Not only will people with Medicare receive more coordinated, seamless care that addresses their unique needs, but CMS is supporting primary care clinicians and giving them more flexibility to provide person-centered care.”
Companies featured in this article:
