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CMMI Announces New Serious Illness Payment Model Based on C-TAC Proposal

HHS Secretary Azar, CMS Administrator Verma and CMMI Director Boehler Acknowledge C-TAC’s Contributions to Model Development

The Center for Medicare & Medicaid Innovation (CMMI) has announced the much-anticipated new payment model to support Americans living with advanced illness, which will operate under the new Primary Cares Initiative. The new model, Primary Care First, will include elements of the proposal C-TAC submitted to the U.S. Department of Health and Human Services (HHS), as well as the proposal submitted by the American Academy of Hospice and Palliative Medicine (AAHPM).

Primary Care First is part of a compilation of new models known as Primary Cares. Under Primary Care First, providers would receive upfront payments for treating a focused population of patients with serious illness, aligning closely with C-TAC’s mission to promote value-based, person-centered care. HHS plans to allow providers to apply for the new model by this summer and launch the program in January 2020.

Payment and delivery reform for advanced care has been at the core of our work for a decade and the demonstration of this model is a landmark achievement for C-TAC. While our original Advanced Care Model was designed as a standalone model, integrating advanced care in Primary Cares is a natural fit that will ensure people with advanced illness receive coordinated, high-quality care by strengthening the continuum of care.

The announcement was made today by HHS Secretary Alex Azar, Center for Medicare and Medicaid Services (CMS) Administrator Seema Verma and CMMI Director Adam Boehler during an event held at the American Medical Association. The presenters specifically acknowledged the contributions made by C-TAC, AAHPM and other groups to submit and refine proposals which informed the new Primary Care First model.

“C-TAC is thrilled to learn that CMMI will conduct a demonstration of a model that will transform the way that advanced illness care is delivered,” said C-TAC co-chair and co-founder Tom Koutsoumpas, who was instrumental in advancing the original Medicare Hospice Benefit. “This model will be a critical component in the continuum of care and we are eager to focus our expertise and resources on bringing that continuum to life.”

Everyone who lives with advanced illness deserves high-quality, person-centered care that is consistent with their goals and values and honors their dignity. By changing the way that care is delivered and paid for, we can make strides in ensuring that patients receive the care they want in the setting that is right for them.

Primary care providers are crucial allies in providing high-quality advanced care, both in terms of the services they offer directly as well as their ability to coordinate or refer patients to specialists for additional palliative care services. C-TAC will collaborate and engage with leaders in primary care, reinforcing our leadership role throughout the demonstration development process and serve as a resource for those primary care providers seeking guidance on the model.

In addition to primary care providers, C-TAC will continue to connect our diverse membership with the resources they need to ensure that the demonstration process is successful. We will also reinforce our leadership role by collaborating with relevant stakeholders from application to implementation.

C-TAC will connect eligible demonstration applicants with those who can provide support in a variety of areas, from crafting application proposals to training in developing the demonstration care model.

We will also serve as a key convening resource for CMS to gather lessons and share challenges in real time, serving as a conduit between interested applicants and CMS. Everyone has a role to play in this demonstration and C-TAC looks forward to playing a key role in making Primary Care First a success.

Today’s announcement builds on a commitment issued by CMMI Deputy Director Amy Bassano during the 2018 C-TAC Summit, when she told attendees that an advanced illness-focused alternative payment model announcement would be forthcoming.

This announcement marks a tremendous step forward for the advanced care movement. C-TAC applauds CMMI and our partners at AAHPM for their support and dedication during this process. With this accomplishment, C-TAC has moved substantially closer to fulfilling our goal of ensuring that people with advanced illness receive compassionate, high-quality care.

More information about Primary Care First is available in this fact sheet, provided by CMS.

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