Benefits of HBPC HCCIntel

Slowly Getting Serious: The New CMS Primary Care Models And Implications For Serious Illness Care

|  Health Affairs | Mark Japinga, Mathew Alexander, David Casarett, William K. Bleser, Mark B. McClellan, Robert S. Saunders

In April, the Centers for Medicare and Medicaid Services (CMS) introduced five new payment models as part of its Primary Care First (PCF) and Direct Contracting (DC) programs. The models represent CMS’s latest push to move primary care providers away from fee-for-service payments and into care models that focus on total cost of care, using varying levels of capitated payments that can help facilitate investment in critical services not sufficiently reimbursed under fee-for-service, such as care coordination, 24-hour call centers, and home visiting.

Care for high-risk, high-need patients earns significant attention, especially in the Serious Illness Populations (SIP) track within PCF. This model specifically builds on proposals from the American Association for Hospice and Palliative Medicine (AAHPM) and the Coalition to Transform Advanced Care (C-TAC) and offers the clearest glimpse yet into how CMS is incorporating new delivery models targeting this population.

The implementation challenges for practices will be similar to those found by our recent work on serious illness care in accountable care organizations (ACOs). This includes a national survey and case studies on diverse ACOs with mature serious illness care programs and sustained success in ACO models, which chronicled how some ACOs are going beyond simply identifying a serious illness population and working to transform their care. This research is especially relevant given that PCF and SIP, as currently described, focus more on improving whole-person care for high-risk patients with multiple chronic conditions, centralized in primary care settings. This is a key distinction from the AAHPM and C-TAC models, which focus on advanced illness, pre-hospice, or end-of-life care with a strong role for palliative care teams. In other words, these models may serve as a bridge to more comprehensive, person-focused serious illness care approaches in the coming years.

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Benefits of HBPC HCCIntel Training Training & Education

House Calls Are Reaching the Tipping Point — Now We Need the Workforce

home-based primary care training and education

Written by: Thomas Cornwell, Home Centered Care Institute; Northwestern Medicine Regional Medical Group
Journal of Patient-Centered Research and Reviews


Home-based primary care (HBPC) improves the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of HBPC, and improved payments for HBPC. There are 2 million to 4 million patients who could benefit from HBPC, but only 12% are receiving it. The number of these patients is expected to double over the next two decades. This requires a larger and better prepared HBPC workforce, making St. Clair and colleagues’ article published within this same issue very timely. They showed residents exposed to HBPC had increased interests in providing HBPC in the future. They also found HBPC training fulfilled all 6 Accreditation Council of Graduate Medical Education core competencies and at least 16 of the 22 Family Medicine Milestone Project subcompetencies. Such medical education curricula are necessary to sufficiently develop a future workforce capable of appropriately providing HBPC to an increasing number of patients.

Recommended Citation

Cornwell T. House calls are reaching the tipping point — now we need the workforce. J Patient Cent Res Rev. 2019;6:188-91.

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Benefits of HBPC Event Events HBPC in the News HCCIntel Legislative News Uncategorized

AAHCM and HCCI present a webinar on new CMS Primary Cares Payment Models

Woman watching a webinar

The American Academy of Home Care Medicine (AAHCM) in collaboration with the Home Centered Care Institute (HCCI) will host a webinar Tues. July 30 at 4 pm (ET) on the new CMS Primary Cares Initiative payment models relevant to home care medicine. The three different payment models will be discussed in detail; Primary Care First (PCF), Seriously Ill Population (SIP), and Direct Contracting (DC).


CMS Primary Cares Initiative

In April, the Center for Medicare and Medicaid Innovation (CMMI) announced a CMS Primary Cares Initiative which includes new payment demonstrations meant to promote value-based care, with a shift of up to 25 percent of primary care Medicare fee-for-service patients to these new models. Primary Care First (PCF), Seriously Ill Population (SIP), and Direct Contracting (DC) will offer enhanced payment for home care medicine and other providers to provide primary care for people with advanced illness.

Primary Care First (PCF) & Seriously Ill Population (SIP)

The Primary Care First (PCF) and Seriously Ill Population (SIP) models will be offered in 22 states and 4 regions for a January 2020 start date:   STATEWIDE in Alaska, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maine, Massachusetts, Michigan, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, and Virginia. In Local Regions of Greater Buffalo, NY, Kansas City (Kansas and Missouri), Greater Philadelphia (Pennsylvania), North Hudson-Capital Area, NY, and Northern Kentucky.

PCF/SIP Timeline:   A letter of intent (LOI) is not required for PCF or SIP.   A request for application (RFA) will be released in the coming weeks and is required for participation.  Both models are scheduled to begin January 2020.

Direct Contracting

The Direct Contracting (DC) path will engage practices or groups of providers who can reach 5,000 beneficiaries by Year 3 (with potential exceptions for smaller practices), as well as Health systems, Accountable Care Organizations, Medicare Advantage plans, and Medicaid Managed Care Organizations.  DC builds upon the Next Generation ACO model and has no geographic limitations on who may apply.   The DC path will include three models: Professional PBP, Global PBP, Geographic PBP (Proposed).

Timeline:  A Letter of Intent (LOI) is required to apply for participation in the DC Models and is due on Friday, August 2. The LOI is non-binding. CMS will then release the request for application (RFA), which will be required for participation. All models are scheduled to begin January 2020 except the DC Geographic Option, which will begin at a later date.

HCCIntel Practice Management Tip of the Month Training & Education

Why is HCC Coding so Important for Home Care Medicine?

Medical coding

A hot topic in health care today is Hierarchical Condition Categories (HCCs), and there is no better time to consider the value of HCC coding to your home-based primary care program!  HCC coding is the risk adjustment method used by Centers for Medicare and Medicaid Services (CMS) to determine the annual payments for patients in Medicare Advantage plans.  HCC risk adjustment uses predictive modeling to determine the severity of patients’ conditions, health risk, and status to project the cost of health care coverage for that population.  This is how CMS determines cost savings for patients enrolled in Accountable Care Organizations and the Independence at Home Medicare Demonstration, and HCC risk adjustment will also determine into which Practice Risk Group patients will be placed for the new Primary Care First Model.

Correct diagnosis coding is always important, but it is critical for accurate risk adjustment because it drives appropriate reimbursement for provider services in value-based payments.  An easy “best practice” to initiate is to always code to the highest specificity.  Unfortunately, Electronic Health Records (EHRs) complicate this because the search list populated for diagnosis codes frequently brings the unspecified codes to the top of the list. To overcome this challenge, we recommend creating a list of HCC diagnosis “favorites” that will more easily display for selection. Check if your EMR can highlight diagnoses that map to HCC scores.  Partnering with a certified medical coder can assist in ensuring accuracy in the common conditions included as “favorites,” especially for disease combinations such as diabetes with chronic kidney disease. In addition, you can also consider running a diagnosis utilization report to identify your most frequently treated HCC diagnoses and then review and update your problem lists so you can be as specific as possible for patients with those conditions.

Correct coding is essential for accurately predicting future health care costs for patients and ensuring the appropriate reimbursement for providers.

To enhance your understanding of which conditions carry a risk adjustment factor, download our HCC Resource Sheet for Home-Based Primary Care (HBPC) which provides a list of common HBPC diagnoses for HCC scoring.