CMS to launch new direct-contracting pay models in 2020

HHS on Monday launched an ambitious, double-pronged strategy to shift primary care from fee-for-service payments to a global fee model where clinicians and hospitals could assume varying amounts of risk.

HHS Secretary Alex Azar told a crowd of stakeholders at the American Medical Association in Washington that the CMS projects the new voluntary programs will shift at least a quarter of people in traditional Medicare out of fee-for-service.

The first model aims at small primary-care practices, offering two options with a flat monthly fee per patient. Bonuses or penalties will depend on their ability to keep their patients “healthy and at home,” said Adam Boehler, director of the CMS’ Center for Medicare and Medicaid Innovation, or CMMI.

Larger practices and health systems would have additional choices, which could be very lucrative but pose steeper risks. Under the first “professional option,” providers would assume 50% of the risk, including savings and losses. Under the “global option,” providers would take on full risk.

There is also a “geographic option,” in which health systems or insurance plans could assume the risk for the total cost of primary care for a swath of communities within a particular region.

Most of the newly announced Innovation Center models will launch in January 2020. The geographic option is projected to begin in mid-2020.

The administration officials painted the models as a sweeping overhaul of the fee-for-service model, even though the model is voluntary. Verma said the CMS hopes to incorporate state Medicaid programs as the policy rolls out across the country. Read the full article