The Biden administration has quietly posted updates on several of its payment models as part of a larger review of many of the models.
The Centers for Medicare & Medicaid Services has not said how many of its models are under this review, which ones they are nor when the reviews will be complete, but it did underscore the importance of the models.
“CMS remains steadfast in its commitment to transforming the healthcare system into one that rewards value and care coordination,” the agency told Fierce Healthcare. “The CMS Innovation Center and its alternative payment models help execute on that commitment.”
Below is a running list of updates CMS has posted on payment models:
CHART Model ACO Transformation Track
CMS has delayed the start of the ACO Transformation Track part of the new Community Health Access and Rural Transformation (CHART) model that aims to transform rural healthcare.
The ACO Transformation Track’s request for applications will now be in spring 2022 instead of this year.
The model aims to give up-front investments to rural providers and give capitated payments for quality and health outcomes. The model also hopes to remove regulatory burdens by providing waivers and other flexibilities for rural healthcare providers.
The transformation track would select up to 20 rural-focused ACOs to get advance payments when they join the Medicare Shared Savings Program. The payment would vary based on the level of financial risk that a CHART ACO will take.
The National Association of ACOs said in a statement it was disappointed in the delay, noting it was a “short-term setback”
Primary Care First
CMS recently announced that the seriously ill population component of the Primary Care First model is under review. The component was expected to start April 1, but now it will not begin.
The component aims to improve care for higher-need and seriously ill Medicare beneficiaries that lack a primary care doctor or need effective care coordination.
Providers that participate in the option also have to demonstrate they have a network of relationships with other caregivers to ensure beneficiaries have the right care for long-term needs.
Geographic Direct Contracting
The model aims to pay providers based on spending and quality metrics tied to an entire region’s health outcomes, but it has gotten pushback from groups like the National Association of ACOs, which said it could confuse patients who don’t know they are in the model.
CMS does not say how long the review of the model will last. The Trump administration posted a request for applications Jan. 15.
The model has two three-year performance periods, the first of which will run from Jan. 1, 2022, through Dec. 31, 2024.
Kidney Care Choices
The Kidney Care Choices first performance year was set to start Jan. 1, 2021, but it has now been pushed back to January 2022.
The model is intended to give providers a capitated payment based on the total episode of care for dialysis from the treatment of chronic kidney disease all the way through transplantation and post-transplant care.
Providers had 2020 as an implementation period to build the necessary infrastructure for the model, but now that period is extended for this year.
Part D Payment Modernization Model
CMS has kept this model aimed at overhauling Part D payments intact but did announce that it will walk back two major changes proposed under the Trump administration.
One change would allow Part D plans participating in the model to treat five of the six protected drug classes as they would other drug classes. Part D plans are required to cover all drugs in the protected class but under the change, they could pick and choose which drugs to cover.
Another change ensures that Part D plan model participants can include on their formulary at least one drug per class instead of two currently required.