- The National Association of Accountable Care Organizations is asking CMS to make changes to its primary care direct contracting payment model, including an increase to the shared savings rate from 50% to 75%.
- The group asked for more details on the financial methodology to be released immediately, saying members "are finding the lack of information a tremendous hindrance to participation." Applications for 2021 are due in about three months while the window for participation in the implementation period closes next week.
- In a letter addressed Thursday and sent to Center for Medicare and Medicaid Innovation Director Brad Smith, NAACOS also requests CMS make public the algorithm that will be used to identify high-needs patients and provide potential participants greater flexibility when applying.
CMMI announced the primary care model in April 2019, touting it as a major shakeup for basic healthcare services. The five-year program has two tracks — a professional model with 50% shared savings and losses and a global model with 100% risk sharing.
It includes capitated payments for Medicare fee-for-service beneficiaries, but the ACO group said direct contracting entities are confused about what uses for the payments will be allowed.
NAACOS stressed that it is supportive of the direct contracting track and "very much wants the model to succeed," but said CMMI should heed lessons learned from previous alternative payment models like the Medicare Shared Savings Program and Next Generation ACO model.
Foremost, the association said ACOs weighing participation need more information about the program's benchmarking, risk adjustment and capitated payments. "Without these details, it's impossible for the healthcare community to make informed decisions about program participation," NAACOS wrote.
The group also wants CMS to include more clinical metrics in the list of measures used to determine quality scores and to rely less on Consumer Assessment of Health Providers and Systems surveys.
Providers have expressed frequent frustration with the CAHPS forms and their administration. Hospitals have suggested changes to the surveys, including a shortened questionnaire and digital mode of delivery.
NAACOS also requested additional application cycles for the direct contracting program and aligning deadlines better with MSSP. "This would help ease the application process and avoid a situation where an ACO is forced to decide on participation in one model without having the full information from another," it wrote.
Smith is new to CMMI, coming on board last month to replace outgoing head Adam Boehler. He was previously chief operating officer for Anthem's diversified business group after the payer acquired Aspire Health, a palliative care provider Smith founded in 2013.