Specialty Practitioner Payment Model Opportunities: General Information

The Center for Medicare & Medicaid Innovation (CMS Innovation Center) is interested in testing new models of care that will focus on specific diseases, patient populations, and specialty practitioners in the outpatient setting to incentivize improved care, better health, and lower costs. Through section 1115A of the Social Security Act, as enacted by section 3021 of the Affordable Care Act, the Innovation Center is authorized to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care for Medicare, Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries.

Background

The CMS Innovation Center is interested in testing new models of care that will focus on specific diseases, patient populations, and specialty practitioners in the outpatient setting to incentivize improved care, better health, and lower costs. In this context, the term ‘specialty practitioners’ is used to differentiate these practitioners from primary care practitioners. These models would complement CMS’ existing portfolio, which already includes models focusing on both primary care and inpatient hospitalizations as well as care in other settings. The payment structure for these models could include procedural episode-based payment opportunities, complex and chronic disease management episode-based payment opportunities, or other innovative arrangements.

Initiative Details

The CMS Innovation Center issued a Request For Information (RFI) seeking information in relation to the development of models for care managed by specialist practitioners other than medical oncologists, as a potential oncology model is on a separate development track. The submission period for the RFI concluded April 10, 2014.

Additional details on the specialty practitioner payment models will be posted here as they become available. For more information, please contact SpecialtyCareModels@cms.hhs.gov.

Additional Information



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