Last week, CMS released information on a set of five new voluntary Accountable Care arrangements for Medicare PPS providers. Fact sheets and descriptions of each of the programs are provided on the CMS website. In a conference speech, CMS Administrator Seema Verma outlined the new program and noted thatLooking forward, you can expect that some of the models we have under development will be mandatory. One reason for mandatory models is that selection effects can be significant in voluntary models.  Selection effects happen when only the providers who would benefit financially from a model choose to participate, thereby reducing the amount of savings that the model can generate. Requiring participation also helps us understand the impact of our models on a variety of provider types, so the data resulting from the model will be more broadly representative.”

The arrangements are broken into two categories termed Primary Care First and Direct Contracting. The Primary Care First models can be implemented with as few as 125 Medicare patients. Note that the models may be limited to selected regions of the country. The Direct Contracting models are more varied, but may also have applicability in rural health systems. Both sets of arrangements are planned for the future, with many of the details still to come. Participants will be selected for a development year – 2020 – with implementation of the model in 2021.

Harvey Licht of Varela Consulting shared some insight with NOSORH leaders stating that “The primary care focus of this arrangement makes it particularly applicable to rural health systems. The two alternative Primary Care First arrangements may have wide applicability. Basically, the approach is to make a global primary care payment per patient and then to provide additional bonuses based upon specific cost and health quality outcomes. There is also a risk-bearing component, placing providers at some level of financial risk for failure to achieve outcomes. The financial risks appear to be more limited than the current risk-bearing ACO arrangements.”

The NOSORH staff, committees and partners are planning resources and education for State Offices of Rural Health and their stakeholders. The NOSORH Policy and Program Monitoring Team meeting on May 22nd at 3 PM eastern will provide a discussion forum for SORH.

Back to Branch