New alternative payment models announced by CMS

New opportunities for clinicians to join Advanced Alternative Payment Models (APMs) are available from CMS. The opportunities, developed by the CMS Innovation Center under the Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10), are designed to improve care and potentially provide incentive payments to clinicians. By giving more clinicians the opportunity to participate in these models, CMS hopes that the benefits of high-quality, coordinated care will be extended to more Medicare beneficiaries.

The new opportunities. CMS announced that it expects to re-open applications for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model and new participants in the Next Generation Accountable Care Organization (ACO) model for the 2018 performance year. In addition, the Innovation Center’s Oncology Care Model with two-sided risk will now be available in 2017, which will qualify the model as an Advanced APM beginning in the 2017 performance year.

2016 APM goals. Last year, HHS set a goal of having 30 percent of Medicare payments flow through APMs by the end of 2016. HHS met its goal 11 months early, at the beginning of 2016. Now, HHS has announced that 72 health plans and states, working through the Health Care Payment Learning and Action Network (LAN), a public-private partnership established by HHS in January 2015, have voluntarily reported on the same payment goals. For these plans and states, which represent almost 200 million of the nation’s covered lives, 23 percent of their 2015 health care spending flowed through APMs.

On October 14, 2016, HHS issued its Final rule with a comment period implementing the Quality Payment Program (see MACRA final regulations reflect input from ‘months-long listening tour’, Health Law Daily, October 14, 2016). In 2017, under the Quality Payment Program, clinicians may earn a 5 percent incentive payment through sufficient participation in the following Advanced APMs:

  • Comprehensive End Stage Renal Disease (ESRD) Care Model (Large Dialysis Organization (LDO) arrangement)
  • Comprehensive ESRD Care Model (non-LDO arrangement).
  • CPC+
  • Medicare Shared Savings Program ACOs – Track 2
  • Medicare Shared Savings Program ACOs – Track 3
  • Next Generation ACO Model
  • Oncology Care Model (two-sided risk arrangement)

In 2018, CMS anticipates that clinicians may also earn the incentive payment through sufficient participation in the following models:

  • ACO Track 1+
  • New voluntary bundled payment model
  • Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology (CEHRT) track)
  • Advancing Care Coordination through Episode Payment Models Track 1 (CEHRT track)

According to CMS, these lists of models will continue to change as more models are proposed and developed in partnership with the clinician community and the Physician-Focused Payment Model Technical Advisory Committee.