Many clinicians to participate in pay-for-quality programs
More than 359,000 clinicians are confirmed to participate in 2017 in four alternative payment models (APMs) created by the Centers for Medicare & Medicaid Services. Clinicians who participate in APMs are paid for the quality of care they give to their patients. The four programs are:
- Medicare Shared Savings Program.
- Next General Accountable Care Organization (ACO) Model.
- Comprehensive End-Stage Renal Disease (ESRD) Care Model (CEC).
- Comprehensive Primary Care Plus (CPC+) Model.
Shared Savings Program ACOs are groups of doctors and other healthcare providers who work together to provide high quality services to Medicare fee-for-service beneficiaries. In 2017, the Shared Savings Program welcomed 99 new participants and 79 renewing participants, bringing the total number of participants to 480 across 50 states, the District of Columbia, and Puerto Rico.
The Center for Medicare and Medicaid Innovation’s (Innovation Center) Next Generation ACO Model was designed to test whether strong financial incentives for ACOs can improve health outcomes and reduce expenditures for Medicare fee-for-service beneficiaries. Provider groups in this model assume higher levels of financial risk and reward than are available under the Shared Savings Program. In 2017, 28 new participants have joined the model, making the total number of 2017 participants 45.
In the CEC Model, dialysis clinics, nephrologists and other providers join together to create an ESRD Seamless Care Organization (ESCO) to coordinate care for matched beneficiaries. The CEC Model received 24 new participants for a total of 47 participants in 2017.
CPC+, also an Innovation Center model, is an advanced primary care medical home model that aims to strengthen primary care through a regionally based multi-payer payment reform and care delivery transformation. In CPC+ Round 1, CMS is partnering with 54 payers in 14 regions with 2,893 primary care practices, which include over 13,000 clinicians, in 2017.
For more information, visit the following fact sheets:
- Next Generation ACO: https://innovation.cms.gov/Files/fact-sheet/nextgenaco-fs.pdf
- Shared Savings Program: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2017-MSSP-Fact-Sheet.pdf
- CEC: https://innovation.cms.gov/Files/fact-sheet/cec-fs.pdf
- CPC+: https://innovation.cms.gov/Files/fact-sheet/cpcplus-fs-rd1.pdf