More clinicians able to join Next Generation ACOs, CPC+ for 2018

For the 2018 performance period of the Quality Payment Program (QPP), a program designed to reform Medicare payments to physicians to improve the quality of care provided, physicians will have additional opportunities to join two Advanced Alternative Payment Models (Advanced APMs). The Next Generation Accountable Care Organization (ACO) model and the Comprehensive Primary Care Plus (CPC+) model will accept new applications for participation early in 2017. Once new applicants are accepted, CMS expects that 25 percent of QPP participants will be part of Advanced APMs for performance year 2018 and eligible to receive incentive payments from Medicare.

The QPP is part of CMS’ implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10), which builds on measures created by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). It consists of two tracks for eligible professional participation: Advanced APMs and the Merit-based Incentive Payment System (MIPS). To participate as an Advanced APM, the eligible professional must be part of certain payment models, including the Next Generation ACO and CPC+ models, both of which were created by the CMS Innovation Center, which was established under section 3021 of the ACA.

The announcement that both models will open for applications in early 2017 follows promises made by CMS two months ago (see New alternative payment models announced by CMS, October 26, 2016). As part of its announcement, CMS released a Fact Sheet on the CPC+ Payer and Practice Solicitation. The American Medical Association (AMA) commended the expansion, saying that, because of Advanced APMs, “physicians will have more time with patients and more flexible payments to support care coordination and improvements in access and quality.”

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.

ACO movement gains steam as more providers, organizations join up

With a number of new providers participating in accountable care organization (ACO) initiatives, this care model is now available in 49 states, plus the District of Columbia. CMS has announced 121 new participants in these programs, which allow providers to offer better quality, coordinated care to reduce costs and burdens on patients. The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) emphasized quality and a patient-centered view of care, offering various tools like Medicare ACOs to move the health care system away from traditional fee-for-service payment arrangements.

Types of ACOs

The Medicare Shared Savings Program (MSSP), created by section 3022 of the ACA, allows providers to work together and reduce redundancy in patient care. Instead of being paid more for ordering more tests, providers are rewarded for quality of care and are able to share in the savings generated by the program. On January 1, 2016, 100 new ACOs and 150 renewing ACOs were participating in the MSSP, serving 7.7 beneficiaries. Some MSSP ACOs are participating in the ACO investment model (AIM), which provides pre-paid shared savings. CMS hopes that this model will encourage more ACO formation in underserved areas.

The Pioneer ACO model is for providers already experienced in care coordination, allowing them to shift toward a population-based payment model. This model involves a higher level of risk along with a generally higher level of shared savings than the MSSP. The Next Generation model was born from the prior models and includes strong patient protections and financial incentives for providers.

Goals

HHS announced last January that it intended to move 30 percent of traditional fee-for-service payments to alternative models by 2016. At the time, ACOs had already saved the Medicare program $417 million. CMS noted that those participating in ACOs in 2013 and 2014 also improved on 27 quality measures.