Primary Care Alternative Payment Opportunity
Enrollment Status: Enrolling now. Open until 7/1/2021
Direct Contracting Entity (DCE): Clover Health Partners / Subcontractor for Indiana: Purdue Healthcare Advisors
If you have questions, please submit a quick inquiry (in the left sidebar) or go ahead and download/fill out/sign the Letter of Participation and email it back to us.
About the Opportunity
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. This Primary Care Alternative Payment Opportunity is a GPDC option that 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.
- Primary care providers (physicians and advance practice 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
- No delay in cash flow like MSSP or Next Gen
- Can participate in a CMS Advanced Alternative Payment Model (AAPM) without having to take on risk
- Will receive the 5% AAPM MIPS bonus
- Could potentially be excluded from reporting MIPS
- Dedicated Quality Improvement Advisor(s) (QIA) to help drive improved quality, health and cost outcomes based on the initiatives and measures you would like to improve
- No mandatory quality measure selection or reporting requirements due to the use of the Clover Assistant tool (see below)
The first performance period under this model begins 4/1/2021. An exit from the program requires only prior written notice.
- be a primary care provider
- be interested in using a population health tool to improve patient care
- not be participating in an Accountable Care Organization (ACO) unless intending to unenroll from that before the year's end
- bill Medicare / at least 100 traditional Medicare FFS patients
- practice in Indiana
- 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
About the Clover Assistant Tool
The Clover Assistant is a web-based application powered by clinical and claims data on Medicare beneficiaries. It supports you in two ways:
- by dynamically surfacing up-to-date, patient-specific information, including care gaps, medications and potential diagnoses; and
- by providing you with a comprehensive view, populated with data from anywhere that aligned beneficiaries have received care.
View the video below for more information.
Assistant Director, Quality Services
Interested in joining the CMS Direct Contracting Program?
Download the Program FAQ Sheet (pdf)
Download the Letter of Participation (pdf)
If you have questions about this opportunity, please submit the inquiry form below.
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