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The Centers for Medicare & Medicaid Services (CMS) this week issued the attached request for information on a potential alternative payment model that would allow direct provider contracting between payers and primary care or multi-specialty groups within the Medicare fee-for-service, Medicare Advantage and Medicaid programs. The model would differ from existing primary care models, allowing practices to take on two-sided financial risk. Under the potential model, CMS would pay a fixed per-beneficiary, per-month payment to cover a range of services, allowing flexibility in the delivery of other billable services. Practices would also be eligible for performance-based incentives for total cost of care and quality. CMS seeks comments on provider experience with direct provider contracting and how this model could be used to reduce expenditures and preserve or enhance the quality of care for Medicare, Medicaid and Children’s Health Insurance Program beneficiaries. Comments are due May 25.
