NHPCO NewsLine Summer 2019 - 20
continued
services you will provide;
determine payment; agree on key
metrics (who, what, when, where,
how); schedule recurrent
meetings to monitor, modify, and
address any issues and concerns.
Payment Model Options
How Can Palliative Care
and Hospice Programs
Participate?
Unlike the PCF models, there are
no limitations on the geographic
locations that can participate in
the DC model options.
Palliative care and hospice
programs should contract with
Direct Care Entities (DCEs).
DCEs will need to secure
Preferred Providers for care
provision to their attributed
beneficiaries. It is important for
palliative care and hospice
programs to understand these
models, including goals, risks,
quality, and payment. Before
entering into a contract with a
DCE, understand your program
cost and your performance data.
Some considerations in
developing your relationship with
a DCE: transparency (share and
communicate openly); define the
eligible population to encourage
appropriate referrals; clarify the
20
Newsline / Summer 2019
The Direct Contracting payment
model options are expected to be
Advanced APMs in 2021. All
options feature enhancements
aimed at encouraging
organizations focused on care for
those with complex chronic
conditions to participate.
Three options are available with
varied level of risks and rewards:
are expected to reduce burden,
support a focus on beneficiaries
with complex, chronic conditions,
and encourage participation from
organizations that have not
typically participated in Medicare
FFS or CMS Innovation Center
models."
CMS will continue to pay claims
for services made outside the
DCE (non-associated providers).
Organizations will have added
flexibility to reduce the FFS
payments not covered under the
capitation arrangements. DCE
and providers must agree in
writing to the percentage of
reduction.
According to CMS, these
"payment model options are
anticipated to appeal to a broad
range of physician practices and
other organizations because they
Professional PBP
Global PBP
* ACO structure with
Participants and
Preferred Providers
defined at the TIN/
NPI level.
* ACO structure with
Participants and
Preferred providers
defined at the TIN/
NPI level.
* 50% shared
savings/shared
losses with CMS.
* 100% risk.
* Primary Care
Capitation equal to
7% of total cost of
care for enhanced
primary care
services.
<<<< Lowest Risk
* Choice between
Total Care
Capitation or
Primary Care
Capitation.
Geographic PBP
(proposed)
* Would be open to
entities interested in
taking on regional
risk and entering
into arrangements
with clinicians in the
region.
* 100% risk.
* Would offer a choice
between Full
Financial Risk with
FFS claims
reconciliation and
Total Care
Capitation.
Highest Risk >>>>
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
NHPCO NewsLine Summer 2019 - 5
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