Advanced Care Model

Today, too many individuals with advanced illness receive care that is fragmented, uncoordinated, or inadequate to meet their needs and personal wishes. Building from successful, scalable advanced illness and community-based palliative care programs, the Coalition to Transform Advanced Care (C-TAC) developed an advanced illness care advanced alternative payment model, the Advanced Care Model (ACM) Service Delivery and Advanced Alternative Payment Model. The ACM is specifically designed to meet the needs of individuals with advanced illness and their caregivers by breaking down silos among professional groups, bridging traditional medical and social services, and creating comprehensive care management of a person’s healthcare needs.

 Scope

Key Features

The ACM delivers comprehensive, person-centered care management, including:

  • Concurrent curative and palliative treatment
  • Care coordination across care providers and settings
  • Comprehensive advance care planning
  • Shared decision making with patient, family, and providers
  • 24/7 access to clinical support

Target Population

The ACM target population is comprised of fee-for-service Medicare beneficiaries with advancing chronic condition(s). To be enrolled:

  • One or more chronic conditions
  • Recurrent or extensive disease: acute care utilization, functional decline and/or nutritional decline
  • High 1-year mortality risk

Payment

The ACM offers a new advanced alternative payment model. Its components include:

  • PMPM care management fee
  • Shared savings and risk through population-based payments that reward performance
  • Incremental integration with existing value-based payments and APMs
  • Physician-focused payment to support participation by specialists and primary care providers, including small physician practices and in rural areas
  • Transitional pathway from volume to value
  • Voluntary multi-payer participation including Medicare Advantage, duals, and commercial payers

Metrics Tied to Payment