Around the nation: CMMI opts not to extend Next Generation ACO Model advisory.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from advisory.com Daily Mail and Mail on Sunday newspapers.
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A Medicare program that kicked off April 1 promises healthcare upstarts more patients and revenue.
But little-known details about the program show that it won t be easy for companies to profit.
Experts say the companies will have to improve care and lower medical costs to succeed.
Clover Health, Iora Health, Oak Street Health, VillageMD, and a number of other hot healthcare upstarts are all participating in a brand-new federal program that promises them thousands of new patients and a big boost to their top lines.
Robert L. Phillips Jr, MD, MSPH; Linda A. McCauley, RN, PhD; Christopher F. Koller, MA
In recent years, public and private payers have been experimenting with new payment methods to drive better care at lower costs, including primary care services. The urgency has been compounded by COVID-19. Over the past 12 months, the pandemic has revealed major weaknesses in a health system built on fee-for-service (FFS) payment tied to face-to-face patient encounters. According to a 2020 survey, more than 80% of 736 primary care physicians (PCPs) surveyed reported finding problems with payment based on volume and extensive documentation.
1 This has left many physicians desiring more financial stability.
Modern Healthcare Illustration / Getty Images
A former senior Trump administration official lambasted the decision, calling it a big blow to value-based care. While some healthcare organizations forged ahead with the GPDC model despite the pandemic, others held off until they weathered the storm. CMMI had told interested organizations that they could join the model after the pandemic ended, so many of them decided to wait to apply.
Now many would-be participants are in limbo, as the agency decides the fate of the model or its possible replacement. The uncertainty has created widespread consternation among existing accountable care organizations and all new direct contracting entities backed by managed-care organizations or venture capital firms. Many of them would have applied for the pilot project last year if they knew CMMI would pause new applications for 2022, experts said.