May 9, 2024
We have a number of CMMI model updates this month. We also invite you to register for our National Policy Collaborative webinar later this month, and welcome a new team member to the State Policy team.
Model Updates
ACO Primary Care Flex
We continue to be excited about the opportunities FLEX offers as the first model in several years to build on the chassis of the Medicare Shared Savings Program. We expect full details from the end of May to early June. In the meantime, we will share everything we hear with you in preparation for an informed and timely decision for your practice. The latest from CMS presenting at the National Association of ACOs:
- Enhanced payments will be significant and represent a major investment in primary care beyond what CMS spends on average in primary care today
- FQHCs and RHCs will have their base rate linked more to average FQHC and RHC spend than to overall primary care spend to account for differences in today’s payments
We have a summary as well as a deeper dive webinar on what we know so far, and will continue to share more information as we learn more. We are excited about the potential for Flex to be a significant investment in primary care. As FLEX upends fee for service, it must be replaced with a better payment model.
GUIDE Model
Some practices might be participating in the Guiding an Improved Dementia Experience Model (GUIDE), which begins July 1 and will run for 8 years. The model will test whether a comprehensive package of care coordination and management, caregiver support and education, and respite services can improve quality of life for people with dementia and their caregivers while delaying avoidable long-term nursing home care and enabling more people to remain at home through end of life.
Newly proposed bundled payment model for hospitals
Finally, the latest model CMS is thinking about is the Transforming Episode Accountability Model (TEAM). CMS is currently accepting comments on this proposed model until June 10, and Aledade will be submitting comments. CMS is proposing that TEAM be a mandatory model for hospitals that aims to improve beneficiary care through financial accountability for episodes categories that begin with one of the following procedures:
- Coronary artery bypass graft (CABG)
- Lower extremity joint replacement (LEJR)
- Major bowel procedure
- Surgical hip/femur fracture treatment (SHFFT), and
- Spinal fusion
Hospitals would coordinate care for Medicare FFS beneficiaries who undergo select surgical procedures, assuming responsibility for cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital. CMS proposes to test out TEAM for a 5-year performance period, beginning January 1, 2026, and ending December 31, 2030.
Our comments to CMS will focus on ensuring smooth operations between ACOs and participants in TEAM.
State Policy Corner: Register for our National Policy Collaborative
We will be hosting our next National Policy Collaborative focused on lessons learned and what’s ahead for prior authorization reform on Tuesday, May 21, from 6-7pm EST. Please join us to hear from experts across the country, including key legislators who have passed reform bills in their states, on what went well and what can still be improved. This virtual event is open to anyone interested in learning more about lightening the load of primary care administrative workloads. Register here.
Additionally, please join us in welcoming our newest Senior Policy Analyst, Jennifer Lyons, to the team. Before starting at Aledade, Jennifer worked at the Primary Care Development Corporation and is deeply aware of the complex needs regarding primary care sustainability. She has assumed responsibility for leading state policy efforts in the Southeast region.