NHPCO NewsLine Summer 2019 - 19
care coordination to Primary
Care First practices that
specifically opt to participate in
this payment model option.
Option 2:
Under the PCF High Needs
Populations Payment Model, the
practice must include
practitioners serving seriously ill
populations (not yet defined)
(MD, DO, CNS, NP, PA) certified
in internal medicine, general
medicine, geriatric medicine,
family medicine, and hospice and
palliative medicine. Practitioners
must be in good standing with
CMS and must be able to
demonstrate the capability to
manage complex patients by
using an interdisciplinary team
and phased-care approached and
providing comprehensive personcentered care.
DC models focus on
complex chronic,
seriously ill, and
dually eligible
beneficiaries.
Practices may limit their
participation in Primary Care
First to exclusively caring for SIP
patients, but in order to do so,
such practices must demonstrate
in their applications that they
have a network of relationships
with other care organizations in
the community to ensure that
beneficiaries can access the care
best suited to their longer-term
needs. Allowances to some of the
eligibility requirements for the
Primary Care First general
payment model option (such as
with respect to historical
beneficiary attribution) will be
made to facilitate participation in
the SIP payment model option.
The practice must also
demonstrate ability to engage
with patient and caregivers and
also must provide 24/7 access to
a practitioner or nurse call line.
The practice must also use the
2015 Certified Electronic Health
Record Technology (CEHRT).
Payment
More details on the payment
structure can be found in the FAQ
document on PCF available on
the "Models and Demos" page of
the NHPCO's website.
DIRECT CONTRACTING
The Direct Contracting (DC)
models are part of the CMS
strategy to use the redesign of
primary care to drive broader
delivery system reform to
improve health and reduce cost.
The DC models provide a variety
of risk sharing options, flexible
beneficiary alignment options,
benefit enhancements, and
payment waivers. The DC models
allow new organizations to
participate. The DC models focus
on complex chronic, seriously ill,
and dually eligible beneficiaries.
Payment for SIP patients differs
from that established under the
general payment option for
Primary Care First.
Newsline / Summer 2019
19
https://www.nhpco.org/models-and-demos
https://innovation.cms.gov/initiatives/direct-contracting-model-options/
NHPCO NewsLine Summer 2019
Table of Contents for the Digital Edition of NHPCO NewsLine Summer 2019
NHPCO NewsLine Summer 2019 - Intro
NHPCO NewsLine Summer 2019 - 1
NHPCO NewsLine Summer 2019 - 2
NHPCO NewsLine Summer 2019 - 3
NHPCO NewsLine Summer 2019 - 4
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NHPCO NewsLine Summer 2019 - 38
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