CMS Announces New Payment Model for Regional Value-Based Care

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Each region of the United States has its own unique needs when it comes to value-based care. In fact, a zip code can be the greatest determining factor in a patient’s health. Studies show that although healthcare technology can reduce barriers to care in some rural and low-income communities, this does not guarantee that everyone can access the local physicians and healthcare providers who best understand their patients’ individual needs. This is especially true in the case of Medicare beneficiaries.

To help coordinate care across these barriers, the Centers for Medicare and Medicaid Services (CMS) announced that it will be starting a new “voluntary payment model” that will build “on CMS’ focus to deliver Medicare beneficiaries value through better care and improved quality.” This new program, the Geographic Contracting Model, will “test an approach to improving health outcomes and reducing the cost of care for Medicare beneficiaries in multiple regions and communities across the country.”

Participants will be responsible for “beneficiaries’ health outcomes, giving participants a direct incentive to improve care across entire geographic regions. Within each region, organizations with experience in risk-sharing arrangements and population health will partner with health care providers and community organizations to better coordinate care.”

The New Model

Under the Model, beneficiaries will “maintain all of their existing Original Medicare benefits, including the ability to see any provider they choose. Beneficiaries may also receive enhanced benefits, including additional telehealth services, easier access to home care, access to skilled nursing care without having to stay in a hospital for three days, and concurrent hospice and curative care.”

The program will help those physicians and healthcare providers who choose to participate engage with their community’s unique needs. Participating physicians and healthcare providers will “work within defined geographic regions to maintain and improve care coordination, leveraging beneficiaries’ existing provider relationships and develop innovative care delivery solutions” that are coordinated according to the resources available in their region.

The Model encourages physicians and healthcare providers to “create a network of preferred providers” that has advanced flexibility under the Model “to provide the right care for beneficiaries at a lower cost.” Moreover, it will allow physicians to enter alternative payment arrangements once they are selected, including “prospective capitation and other value-based arrangements.” CMS notes that selected physicians and healthcare providers will be crucial to augmenting “Medicare’s current program integrity efforts, reducing fraud, waste, and abuse in their region and decreasing costs for beneficiaries and taxpayers.”

Deadlines for Application

CMS asks that organizations who are interested in participating submit a letter of interest to this link by December 21, 2020. Applications will be open on January 21, 2021, and organizations must submit theirs by 11:59 P.M. on April 2, 2021. CMS will select participants by June 30, 2021.

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