NEW SERIOUS ILLNESS MODELS FROM CMS Providers Should Understand the Opportunities By Judi Lund Person and Lori Bishop On Monday, April 22, Health and Human Services Secretary Alex Azar and CMS Administrator Seema Verma announced the CMS Primary Cares initiative at a meeting attended by NHPCO leadership and other stakeholders in the field. The initiative is under the direction of the CMS Innovation Center. The purpose of the CMMI is to test innovative payment and service delivery models to reduce program expenditures... while preserving or enhancing the quality of care furnished to individuals under such titles. There are three scenarios for success under the statute guiding CMMI's work: 1. Quality improves; cost neutral. 2. Quality neutral; cost reduced. 3. Quality improves; cost reduced (best case). If a model meets one of these three criteria and other statutory prerequisites, the status allows the Secretary to expand the duration and scope of a model through rulemaking. The Medicare hospice benefit is an example of a model that was expanded and eventually made a full comprehensive benefit. The Primary Cares initiative includes two sets of new payment models: Primary Care First, and Direct Contracting. The purpose of the CMMI is to test innovative payment and service delivery models... PRIMARY CARE FIRST Primary Care First (PCF) will be comprised of three new payment models that CMS says are "intended to transform primary care to deliver better value for patients throughout the healthcare system." The models include a PCF High Need Population Payment Model Option for those serving the seriously ill population. In PCF, CMS will rely on a focused Newsline / Summer 2019 17https://innovation.cms.gov/initiatives/primary-care-first-model-options/