Executive Briefing | by Monica E. Oss | September 30, 2013
This summer, the federal Centers for Medicare & Medicaid Services (CMS) announced it has prioritized the development and implementation of a series of initiatives to improve payment for and encourage long-term investment in care management. Why? Because chronic care costs are a big portion of the budget – The Chronic Condition Multiplier Effect On Cost.
There are a number of approaches that Medicare is using to improve and incentivize chronic care management. Here are a few initiatives to keep your eye on.
The Medicare Shared Savings Program For Accountable Care Organizations (ACO) – This program was created under the PPACA to reduce fragmentation, improve population health, and lower overall growth in expenditures. Physician Quality Reporting System (PQRS) reporting requirements and incentive payments were incorporated into the Shared Savings Program. (see Medicare Shared Savings Program Final Rule).
Pioneer ACO Model – This model is a CMS Innovation Center initiative designed to support organizations, allowing them to provide more coordinated care to beneficiaries at a lower cost to Medicare. The Pioneer ACO Model will test the impact of several innovative payment arrangements to support these organizations in achieving the goals of better care and outcomes at a lower cost (see Selected Participants in the Pioneer ACO Model).
Advanced Payment ACO Model – This model is for ACOs participating in the Shared Savings Program, and includes three payment types—an upfront fixed amount, an upfront variable amount based on the number of historically assigned beneficiaries, and a monthly variable payment. CMS will recoup these advance payments from an ACO’s shared savings (see Advance Payment Accountable Care Organization (ACO) Model).
The Primary Care Incentive Payment Program (PCIP) – The PCIP is a quarterly incentive payment program to augment the Medicare payment for primary care services. PCIP began in 2011 and will end in 2015. Incentive payments are equal to 10 percent of the Medicare paid amount for primary care services (see Primary Care Incentive Payment Program (PCIP)).
Multi-Payer Advanced Primary Care Practice Demonstration (MAPCP) – The MAPCP demonstration makes advanced primary care practices more broadly available, and tests whether the quality and coordination of health care services have improved. The demonstration program will pay a monthly care management fee for beneficiaries receiving primary care from Advanced primary care practices (see Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration Fact Sheet).
The Comprehensive Primary Care Initiative (CPC) – The CPC initiative strengthens freestanding primary care capacity by testing a model of comprehensive, accountable primary care supported by multiple payers. The participating primary care practices will receive a monthly care management fee from Medicare for fee-for-service Medicare beneficiaries (see 45 Payers Join CMS Comprehensive Primary Care Initiative).
Fee For Service Physician Payment For Chronic Care Management – Beginning in 2015, Medicare will pay physicians for time spent establishing a care plan and managing that care over 90-day periods. I think of this as a “faux” medical home – or a medical home without the incentives (see Medicare To Pay Physicians Via FFS For Chronic Care Management Services In 2015).
For a deeper look into these initiatives, check out Medicare Programs: Revisions To Payment Policies Under The Physician Fee Schedule, Clinical Laboratory Fee Schedule And Other Revisions .