Advanced Revenue Cycle Analytics: An Overview

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On April 22nd, the HHS and CMS announced the new CMS Primary Cares Initiative. The goal of this initiative is to reduce administrative burdens and free up primary care physicians to focus on caring for patients, all while cutting down healthcare costs. This move by CMS shows the continual industry trend towards value-based care. If value-based care has not yet affected your practice, it will soon.

There are five payment models under this new initiative, and they are divided into two paths – Primary Care First and Direct Contracting.

The 5 payment model options

1. Primary Care First (PCF) – General

The PCF model is for advanced primary care practices who are prepared to face financial risk in exchange for a reduced administrative burden as well as performance-based payments. There will also be new and higher payments for those practices who care for the complex and chronically ill patients.

2. Primary Care First – High Need Populations

This second model encourages primary care physicians to take on the seriously ill populations, referred to in this model as SIP.

3. Direct Contracting – Professional

Professional Population-Based Payment Direct Contracting Entities (DCE) will bear 50% of shared savings as well as losses for beneficiaries. They will receive “Primary Care Capitation,” which is a capitated and risk-adjusted monthly payment for all services provided by DC Participants and Preferred Providers with whom the DCE has an agreement.

4. Direct Contracting – Global

The Global PBP DCEs will bear 100% of shared savings as well as losses for beneficiaries. They also have the option of enrolling in Primary Care Capitation (as mentioned above), or Total Care Capitation. Total Care Capitation refers to a capitated, risk-adjusted monthly payment for all services provided by DC Participants and Preferred Providers with whom the DCE has an agreement.

5. Direct Contracting – Geographic

Geographic PBP DCEs will bear risk for 100% of shared savings/shared losses on the total cost of care for aligned beneficiaries in a target region. Geographic PBP DCEs will be selected as part of a competitive application process and commit to providing CMS a specified discount amount off of total cost of care for the defined target region.

Visit the CMS website for more information about the Primary Cares Initiative. For weekly industry updates & insights, follow our blog.