Modern Healthcare April 11, 2020
The CMS is trying to create a Medicare Advantage-like alternative payment model that bypasses insurers, but it’s an uphill battle because the agency is hemmed in by Medicare’s benefit structure.
As a part of that, the Center for Medicare and Medicaid Innovation is prioritizing voluntary alignment—its term for when a Medicare beneficiary chooses a primary-care provider for attribution in a risk-based payment model—above claims-based, prospective assignment in its new Direct Contracting Model. The Innovation Center is doing that in an attempt to increase beneficiary engagement and help providers better manage risk through their relationships with patients.
The Innovation Center has “been interested in trying to get some of the outcomes of Medicare Advantage but not have the insurance company as...