CMS’ ACO Primary Care Flex Model Could Offer Home-Based Care Providers Risk-Based Opportunity – GWC Mag

The Centers for Medicare & Medicaid Services (CMS) announced a new voluntary model Tuesday – centered around primary care providers – that could offer home-based care providers more opportunity to dive into risk-based care.

Dubbed the ACO Primary Care Flex Model (ACO PC Flex Model), it will provide one-time advanced shared savings payments and monthly prospective primary care payments to Accountable Care Organizations (ACOs) to empower primary care providers, according to a CMS release.

The model was another creation of the CMS Innovation Center.

But here’s the key note for home-based care providers:

“People whose primary care provider participates in the ACO PC Flex Model may get care in more convenient ways, like care based at home or through virtual means, extra help managing chronic diseases, and more preventive health services to keep them healthy,” CMS Administrator Chiquita Brooks-LaSure said in a statement.

The National Association of ACOs (NAACOS) applauded CMS for the move, suggesting this was a step in the right direction for risk- and value-based care.

“The National Association of ACOs (NAACOS) applauds CMS for launching the ACO Primary Care Flex model, which will allow Medicare Shared Savings Program (MSSP) ACOs to offer prospective population-based payments for primary care,” the advocacy organization wrote in a statement. “NAACOS has been advocating for this approach, which will bolster primary care practices in ACOs. Shifting to prospective payments provides primary care practices with stable and predictable cash flow needed to transform care delivery and provide comprehensive, team-based care.”

Primary care providers and home-based care providers currently, and generally, have transactional relationships.

But under a more value- and risk-based lens, they need each other on a higher level.

“When a primary care doctor owns that outcome, these value-based primary care providers – which isn’t the majority of who home health is dealing with – absolutely care whether that patient goes to an ER, goes to a hospital, and would want to be available 24 hours per day to help avoid that outcome, which is great for them and the patient,” CenterWell President Sanjay Shetty recently told Home Health Care News.

Home-based care providers have begun to find success in risk-based care through these ACO and primary care provider setups. They fill the gaps, and are able to see and treat patients where primary care providers cannot.

The ACO PC Flex Model, theoretically, should offer even more of those opportunities for home-based care providers.