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Medicare unveils new primary care APMs

04/24/2019 4:14 PM | Anonymous

This week, the Centers for Medicare & Medicaid Services (CMS) announced new, voluntary value-based payment models for primary care: Primary Care First and Direct Contracting. Applications are expected to open shortly and both models will begin in Jan. 2020 for a five-year period. Both are expected to qualify as advanced alternative payment models (APMs).

  • The Primary Care First model is designed for small practices and provides a monthly population-based payment, flat primary care visit fee, and a performance-based payment adjustment to incentivize reduced hospital use. There is a second payment track under this model that will focus on seriously ill patient populations.  
  • The Direct Contracting model is geared toward larger organizations with at least 5,000 Medicare beneficiaries that have experience taking on financial risk. There are three variations of the Direct Contracting model with increasing levels of risk-sharing and reward. 

MGMA supports CMS’ efforts to create additional voluntary APMs and will work with the agency as it irons out details for each model.

This article originally published in the 4/24/2019 MGMA Washington Connection

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