Advanced Care Model

Currently, too many people living 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, C-TAC developed an advanced illness care advanced alternative payment model, the Advanced Care Model (ACM). The ACM is specially 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.

Key Features

The ACM delivers comprehensive, person-centered care management.

  • 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:

  • Chronic condition must be causing irreversible clinical, functional and/or nutritional decline
  • Clinician must attest that the individual is likely to die in the next year

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 payors

Metrics Tied to Payment