CMS mulling direct provider contracting models
- CMS is seeking input on direct provider contracting between payers and primary care or multi-specialty groups to help it potentially design and test a model for Medicare fee-for-service and Medicare Advantage plans as well as Medicaid.
- Such a model could enrich the doctor-patient relationship by eliminating administrative burden and increasing flexibility around patient care, improving quality while reducing costs, the agency said Monday in announcing the Request for Information.
- The concept grew out of an earlier RFI that sought guidance on a “new direction” for the Center for Medicare and Medicaid Innovation to promote patient-centered care and test market-driven reforms. More than 1,000 stakeholders responded to that RFI, including the American Hospital Association, Federation of American Hospitals and Electronic Health Records Association.
Under the model, CMS would directly contract with Medicare providers and suppliers, such as physician group practices, and they in turn would agree to be accountable for the costs and quality of care of a specific beneficiary population. The model would differ from existing primary care models, allowing practices to take on two-sided financial risk, the RFI says.
Such models would increase flexibility around patient care by improving the revenue stream for providers and suppliers, CMS says.
For example, CMS would pay a fixed per beneficiary per month payment to cover a range of services, allowing flexibility in the delivery of other billable services. Practices would also be eligible for performance-based incentives for total cost of care and quality.
CMS Administrator Seema Verma has said the administration supports the shift to value-based payment models, but it also wants to reduce physicians’ administrative burdens. The model could test ways to do that via changes in claims submission processes for services included in the fixed monthly rate, the RFI says.
As that quest to pay for value picks up speed, one general theory for streamlining care and reducing costs is to cut out middlemen where possible. This model, though not thoroughly described in the RFI, seems to have that aim.
The request asks for input on six focus areas: provider/state participation, beneficiary participation, payment, general model design, program integrity and beneficiary protections, and existing CMS initiatives.
CMS notes other payment models include aspects of DPC and could be tweaked to test DPC models in a step-wise manner with more options added over time.
The goal of the CMMI “new directions” effort is to move away from a Washington-can-fix-healthcare mindset and encourage broader input on alternative payment models and other reforms. The earlier RFI focused on market competition, provider choice and patient-centered care — all embodied in the DPC model.
The responses focuses on a number of issues, including increased physician accountability for patient outcomes, improved patient choice and transparency and realigning benefits with patient needs. They also reflected widespread support for initiatives that focus on chronically-ill patients and those that reduce regulatory burden.