Message from our partner, APG:

CMS Adjustments to Innovation Center Models

May 21, 2020

APG Webinar Recap

Background

The Centers for Medicare and Medicaid Services (CMS) announced adjustments to various Innovation Center models of care in due to the ongoing COVID-19 public health emergency. As outlined in a blog from CMS Administrator Seema Verma, models such as Bundled Payments, Direct Contracting, Medicare Track 1+ and Next Generation ACOs were all extended flexibilities related to financial methodologies, quality reporting, and timelines.

Outlined below are some of the new flexibilities offered within specific programs:

Direct Contracting (Global and Professional)

  • Delay start of the first Performance Period to April 1, 2021
  • Second cohort to launch January 1, 2022 with application cycle created in 2021
  • Adjust model to reflect change in duration of 2021 Performance Period due to April 1, 2021 start
  • Adjust quality benchmarks, if necessary, to reflect change in duration of 2021 Performance Period due to April 1, 2021 start

Medicare ACO Track 1+ Model

  • Voluntary election to extend agreement for 1 year through December 2021
  • Remove episodes of care for treatment of COVID-19
  • Medicare Shared Savings Program Extreme and Uncontrollable Circumstances policy applies to 2020 financial reconciliation
  • 2019 Web Interface quality measure reporting deadline extended from March 31, 2020 to April 30, 2020
  • Medicare Shared Savings Program Extreme and Uncontrollable Circumstances policy applies to 2019 and 2020 reporting
  • Continue to monitor impact on 2020 quality reporting

Next Generation ACO (NGACO)

  • Extend model through December 2021
  • Reduce 2020 downside risk by reducing shared losses by proportion of months during the PHE
  • Cap NGACOs’ gross savings upside potential at 5% gross savings
  • Remove episodes of care for treatment of COVID-19
  • Use retrospective regional trend, rather than prospective, for 2020
  • Remove 2020 financial guarantee requirement
  • 2019 Web Interface quality measure reporting deadline extended from March 31, 2020 to April 30, 2020
  • 2019 quality audit canceled
  • Continue to monitor impact on 2020 quality reporting

Bundled Payments for Care Improvement Advanced

  • Option for Participants to eliminate upside and downside risk by excluding Clinical Episodes from Reconciliation for Model Year 3 (2020)
  • For BPCI-Advanced Participants that choose to remain in two-sided risk, exclude certain Clinical Episodes from Reconciliation with a COVID-19 diagnosis during the episode

See our recent joint webinar on Future of APMs

APG and CareJourney recently did a joint webinar on future of APM’s. Access the webinar by filling out the form above.

Listen at your convenience as Aneesh Chopra, President of CareJourney, and Valinda Rutledge, Senior Vice President of Federal Affairs at America’s Physician Groups (APG) along with a panel of experts discuss the unique insights into the future of risk-based as the fight against COVID-19 continues.

A few questions discussed were:

  • What is the future state of risk-based models in a post-COVID-19 world?
  • What is the continued value offered by staying in risk-based models?
  • What factors should we consider in moving forward in risk-based care?

Expert Panelists

Brad Smith, Deputy Administrator and Director, Center for Medicare and Medicaid Innovation (CMMI)
Marion Couch, Senior Medical Advisor, Office of the Administrator, Centers for Medicare & Medicaid Services
Steve Neorr, Chief Administrative Officer, Triad HealthCare Network
Melanie Matthews, CEO, Physicians of Southwest Washington
Pamela Pelizzari, Principal and Healthcare Consultant, Milliman

Watch Replay