New Payment Model Drives Value-Based Payment for Primary Care

The Centers for Medicare and Medicaid Services (CMS) has announced a renewed effort to bring value-based reimbursement and capitated payment to primary care after a steady expansion of this approach for inpatient hospital care.

Beginning in January 2020, the initiative will roll out five new payment options that the agency hopes will appeal to a broad swath of providers. The models allow providers to receive a single, capitated monthly payment and earn higher reimbursement for specializing in care of patients with complex, chronic needs and seriously ill populations. Some of the models also reward providers with higher payments based on patient outcomes such as controlling high blood pressure, managing diabetes, and screening for colorectal cancer.


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