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A review of payment models under CMS’ Center for Medicare and Medicaid Innovation (CMMI) is quietly under review to decide if they will be implemented. The pause or delays are under the direction of new leadership Director, Liz Fowler.
Primary Care First Delayed
A review of the Primary Care First payment model’s seriously ill population is under review by CMMI. The payment model was slated to start April 1 but is delayed.
The goal of the model is to improve care for the seriously ill patient population covered by Medicare that do not have a primary care practitioner or care coordination.
Global and Professional Direct Contracting Models Paused
CMMI developed the Global and Professional Direct Contracting to advance risk-sharing arrangements that pays providers based on spending and quality measures for an entire geographic region. Participants would be responsible for the total cost of care for a portion of Medicare fee-for-service beneficiaries in a specific region. A direct contracting entity such as an ACO would partner in risk-sharing arrangements with healthcare partners and community organizations to coordinate care. The plan was to transition existing ACOs to the new model. That is no longer an option.
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