New developments in APMs

What you should know right now to stay up-to-date on APMs

★ The Center for Medicare & Medicaid Innovation (CMMI) has launched more than 50 alternative payment and care delivery model tests,

with 33 models now or still operational. Read the CMMI’s sixth report to Congress on its progress. During the period of this report more than 41,500,000 Medicare and Medicaid beneficiaries and individuals with private insurance in multi-payer model tests have been impacted by, have received care from, or will soon be receiving care furnished by the more than 314,000 health care providers and/or plans participating in the CMS Innovation Center payment and service delivery models and initiatives.

★ CMS Innovation Center (aka CMMI) released a report on a Strategic Refresh and indicated a new mandatory model

as part of the refresh to engage specialty care. Things of note in the report include:

• a roadmap for how the Innovation Center will continue to execute its strategy
• a greater focus on integrating specialty care into models
• a two-year extension of the Bundled Payments for Care Improvement (BPCI) Advanced model and
• the development of a mandatory episode payment model in 2023

★ Walmart and UnitedHealth officially announced their value-based care partnership

that begins next year with 15 sites in Florida and Georgia. The partnership of these two giant U.S. companies further increases value-based payment arrangements through Medicare Advantage plans. The arrangement will also expand virtual care services to 20 million of UnitedHealthcare’s commercial members. Read available details here.

★ 2022 APM Incentive Payment Details Available; Learn if Action Needed

The Centers for Medicare & Medicaid Services (CMS) has published 2022 Alternative Payment Model (APM) Incentive Payment details on the Quality Payment Program (QPP) website. To access this information, you can log in to the QPP website using your their HARP credentials. Eligible clinicians who were Qualifying APM Participants (QPs) based on their 2020 performance should have begun receiving their 2022 5% APM Incentive Payments earlier this summer. Review the 2022 Learning Resources for QP Status and APM Incentive Payment (ZIP) for details.

★ What Do I Need to Do in Order to Receive the APM Incentive Payment?

You will not need to do anything to receive your payment, unless CMS is unable to verify your Medicare billing information.

If you have not begun to receive your payment, you should check for your name in the 2022 QP Notice for APM Incentive Payment Zip File on the QPP Resource Library, which indicates that you will need to verify your Medicare billing information. If you do not verify your Medicare billing information by November 1, 2022, then CMS will not be able to issue your APM Incentive Payment. For instructions on how to verify your Medicare billing information, review the Zip File.

★ APM Incentive Payment Details Available on QPP Website

CMS has taken time to ensure correct payments and information are available during the 2022 payment year. CMS’s process includes verifying eligible clinicians’ Advanced APM participation and the calculation of the APM Incentive Payment. You can now log in to the QPP website to see the amount and the organization paid for both the 10-digit National Provider Identifier (NPI) and the organization.

★ Live or moving to California?

overview of Medicare ACOs in California from The SCAN Foundation.

★ Highlights from the AMA Annual Meeting:

Help private practices build their part in new payment models

Current Medicare payment system on an unsustainable path

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