Key Insights

• Following an executive order by President Trump, CMS announced a model to improve healthcare in rural areas by offering value-based payments. 
• The two-track model includes $75 million in seed funding as well as opportunities for rural accountable care organizations to enter two-sided risk arrangements. 
• “The Trump Administration has placed an unprecedented priority on improving the health of the one in five Americans who live in rural areas,” said CMS Administrator Seema Verma.

Introducing the CHART Model

The Centers for Medicare & Medicaid Services (CMS) announced an “initiative to transform rural health” by “unleashing innovation through new funding opportunities that will increase access and improve quality.” 

The Community Health Access and Rural Transformation (CHART) Model, which follows a recent executive order by President Trump, aims to link payments to value, increased choices, and lower patient costs. The model will provide support “through new seed funding and payment structures, operational and regulatory flexibilities and technical and learning support.” 

“The CHART Model represents our next opportunity to make investments that will transform the rural healthcare system, allowing us to use every lever to support all Americans getting access to high-quality care where they live,” said CMS Administrator Seema Verma. 

How the Initiative May Transform Rural Health

The Model features two tracks. Under the Community Transformation Track, CMS will invest up to $75 million in funding for up to 15 rural communities, to be selected in September. This investment may be used to reform care delivery, stabilize capitation payments, and provide operational flexibilities, such as expanding telehealth. 

The accountable care organization (ACO) track will give ACOs a “one-time upfront payment of at least $200,000 per beneficiary and monthly prospective payments for each beneficiary for up to two years,” according to Modern Healthcare. The program “builds on the success of the ACO Investment Model (AIM), which has saved $382 million over three years.” Participants will enter into two-sided risk arrangements as part of the Medicare Shared Savings Program (MSSP). 

CMS stated that the goals of the model are to: 

• Increase financial stability for rural providers through the use of new ways of reimbursing providers that provide up-front investments and predictable, capitated payments that pay for quality and patient outcomes. 
• Remove regulatory burden by providing waivers that increase operational and regulatory flexibility for rural providers. 
• Enhance beneficiaries’ access to health care services by ensuring rural providers remain financially sustainable for years to come and can offer additional services such as those that address social determinants of health including food and housing. 

Important Takeaways

The announcement from CMS noted that this initiative is designed to benefit patients living in rural areas, who have “worse health outcomes and higher rates of preventable diseases,” and accelerate value-based payment models, which have lagged in rural areas. The announcement also acknowledged the role social determinants of health and “impediments such as transportation challenges [that] disproportionately impact rural Americans and their access to care.”