Payment and Program Financing

New Medicare Alternative Payment Model Provides Opportunities for Home and Community Palliative Care

April 23, 2019 | By Allison Silvers

The Center for Medicare and Medicaid Innovation (CMMI) has announced new payment models, available in twenty-six geographic regions, which could provide exciting new opportunities to provide palliative care in home and community settings. Yesterday, Health and Human Services (HHS) Secretary, Alex Azar, and Centers for Medicare & Medicaid Services (CMS) Administrator, Seema Verma, announced the “Primary Cares Initiative": five new primary care payment models designed to incentivize the entire healthcare system to transition to value-based care and care coordination.

Palliative care programs and hospices are eligible to participate within the options under the new “Seriously Ill Population” option. Payment comprises a monthly per patient fee, as well some limited encounter payments and performance-based payments based on hospitalization rates. CMS will be identifying eligible patients for participating programs based on comorbidities, past utilization, and a proxy for frailty.

“This may be a sea change in US health care, recognizing that people living with a serious illness need a different approach to health care—palliative care teams will be the ones delivering it.”

Allison Silvers
Vice President, Payment and Policy, Center to Advance Palliative Care

The initiative also makes dramatic changes for participating primary care practices, providing fixed payments and similar performance-based payments and losses. Primary care practices participating in the new models will thus have strong financial incentives to improve patient experience and reduce avoidable spending, creating new opportunities for partnership and contracting for palliative care services.

The Request for Applications is expected to be released around June 2019, and the new models should begin operations in January 2020. Currently, a second round of applications is also anticipated.

The following CAPC tools and technical assistance can help programs succeed under this payment model:

Limited information is available on the CMMI website, and a series of webinars will provide more details, on April 30 and May 16, 2019.

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