5 CMS payment models that are under review, delayed

CMS has been quietly reviewing several of its payment models to decide if they will be implemented.

Below is a list of updates CMS has released about its payment models:

1. Community Health Access and Rural Transformation Model ACO Track

CMS has delayed requests for applications from ACOs to participate in the Community Health Access and Rural Transformation Model. The model will not seek applications from ACOs until next spring. This is a one-year delay affecting only ACOs.

The two-track payment model aims to test if upfront investments or prospective beneficiary per month payments will improve rural healthcare access and quality while reducing costs.

2. Primary Care First

CMS is reviewing the Primary Care First payment model's seriously ill population component. The payment model component was slated to start April 1, but it will be delayed. 

The component aims to improve care for the seriously ill population covered by Medicare who lack a primary care practitioner or care coordination.

3. Kidney Care Choices

CMS delayed the start of the first performance year of its Kidney Care Choices payment model. The performance year was slated to start April 1, but it was pushed back to Jan. 1, 2022. 

CMS said the delay was to allow participants "to prepare to take on financial and population health accountability starting in January 2022."

The five-year Kidney Care Choices model aims to encourage better care management for Medicare patients with chronic kidney disease and kidney failure by adding financial incentives.

4. Geographic Direct Contracting

CMS is reviewing the Geographic Direct Contracting Model, a voluntary payment model announced in December. 

The model, which has been criticized by some in the healthcare industry, would pay providers based on spending and quality metrics for an entire geographic region. Under the proposal, participants would take responsibility for the total cost of care for a portion of Medicare fee-for-service beneficiaries in a specific region. Within each region, direct contracting entities, such as ACOs, with experience in risk-sharing arrangements would partner with healthcare providers and community organizations to better coordinate care. 

5. Part D Payment Modernization Model

CMS will not move forward with two with two major proposed changes to the Part D Payment Modernization Model. 

The two changes, set to take effect in 2022, offered insurers more formulary flexibilities. One change would have allowed Part D plans to place just one drug per drug class instead of the required two. Another change would have allowed Part D plans to treat five of the six protected drug classes.


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