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A TURNING POINT FOR MEDICARE PAYMENTS

In an exciting move, the Centers for Medicare and Medicaid Services (CMS) and the Innovation Center announced five new payment models. Collectively, they are called the CMS Primary Cares Initiative, and we see these as a strong improvement to the variety of organizations which can participate in value-based payment models for Medicare. “We recognize that the road to value must have as many lanes as possible,” said CMS Administrator Seema Verma, and these new options clearly reflect the center’s commitment to offering a wide variety of payment models.

These new models add variety to the menu of existing payment arrangements such as Bundled Payments for Care Improvement Advanced (BPCIA) and Medicare Shared Savings Program (MSSP) ACOs. Now organizations of all sizes and provider types will now be able to find the right fit for their unique situation. Healthcare leaders are asking themselves many questions when evaluating these new options.

  • Which model will ensure continued sustainability?

  • Which model best suits business needs and imperatives from governance?

  • Which model will best meet the needs of Medicare beneficiaries by improving their health outcomes and providing better access to care at the right place and time?

Carinal Consulting Group has decades of experience with payer strategy, including evaluating various options for contracting with Medicare. Our team works closely with healthcare leaders, offering expert counsel to choose the best-fit option. We understand the pressures facing providers of all kinds: solo independent practices to regional integrated delivery systems. And it’s our job to cut through the complexity with clear, data-driven recommendations that fit our clients needs and help them meet their strategic, financial and quality goals.

To get started, our team wrote out some key considerations for different healthcare organizations. Check out the sections below and don’t hesitate to reach out to discuss your organization.

This initiative will radically elevate the importance of primary care in American medicine
— Alex Azar, U.S. Health and Human Services Secretary

ABOUT US

The team at Cardinal Consulting Group has decades of experience solving complex business problems across the healthcare industry. We take pride in our highly tailored methodology, which starts with fully understanding the business realities and real-world obstacles facing today’s healthcare leaders. Click below to learn more about our firm.

 

PHYSICIANS AND GROUP PRACTICES

Individual practices and medical groups have new options to engage with Medicare. Primary Care First (PCF) is a model which will be offered in 22 regions nationwide. PCF aims to embed the tenets of enhanced primary care into Medicare payments to achieve the Triple Aim of increased quality and patient experience while managing expenditures.

This model might be a fit if you:

  1. Value your independence and delivering high quality primary care

  2. Understand and employ best practices to manage chronic diseases before patients require acute care

  3. Use care management and/or care coordination functions

  4. Experience with population health analytics tools to make informed decisions regarding patient care

  5. Have a focus on primary care, with at least 70% of practice’s billing revenue from primary care services

HOSPITALS AND HEALTH SYSTEMS

Hospitals and health systems with acute care facilities and physician networks now have more choices for participating meaningfully in value-based payments with Medicare.

ACCOUNTABLE CARE ORGANIZATIONS

CMS has already made a substantial progress in the development of provider networks nationwide through the Medicare Shared Savings Program (MSSP) ACOs. With the finalization of the Pathways to Success, many of these organizations are facing a choice to remain in the MSSP as a BASIC or ENHANCED network after their agreement term ends.

You might want to consider a program renewal under Pathways to Success if you:

  1. Have achieved shared savings or are projected to achieve shared savings before your current agreement ends

  2. You have develoepd

 

CONTACT US

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