CMS Primary Care Advance

About the Program

The Centers for Medicare & Medicaid Services' (CMS) Global and Professional Direct Contracting (GPDC) Model is a set of two voluntary risk-sharing options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare. The CMS Primary Care Advance Alternative Payment Opportunity is a GPDC option from Clover Health Partners, a DCE for which PHA acts as a subcontractor.

The program focuses on reinvesting dollars back into primary care by providing small, primary care practices in Indiana and other states with important financial, reporting, resource and technology benefits such as the Clover Assistant, a web-based application powered by clinical and claims data on Medicare beneficiaries. It supports clinicians by dynamically surfacing up-to-date, patient-specific information including care gaps, medications and potential diagnoses; and provides them with a comprehensive view, populated with data from anywhere that aligned beneficiaries have received care. Along with Clover Assistant, PHA's dedicated Quality Improvement Advisor(s) (QIAs) help drive improved quality, health and cost outcomes based on the initiatives and measures you would like to improve.

Primary care providers can earn at least 30% more revenue per visit on their aligned Medicare fee-for-service beneficiaries. Health care organizations can also gain additional revenue by receiving a PMPM fee for up to 5 years with no delay in cash flow like MSSP or Next Gen.

Eligible Indiana clinicians must not be participating in an ACO unless intending to unenroll from that before the year's end, and must bill Medicare.

PARTICIPATION OPTIONS

• Option 1: FFS revenue increases for aligned Medicare beneficiaries by at least 30%
• Option 2: Shared savings, no downside
• Option 3: Shared savings with downside risk

TYPES OF SUPPORT

• Tier 1: Dedicated QIAs to help you implement the program
• Tier 2: Tier 1 plus assistance to align value-based incentive strategies and activities as well as optimize workflows and processes to achieve success in population health
• Tier 3: Tier 1 and 2 plus access to national physician experts to guide adoption/implementation of evidence-based clinical programs that address the needs of your vulnerable, high-cost patient populations

Team