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ACP Leads Charge for Greater Care Coordination in APMs

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In recent presentation to PTAC, ACP discussed how its Medical Neighborhood Model would improve care coordination and patient care

June 18, 2021 (ACP) -- The American College of Physicians is continuing to help guide the Physician-Focused Payment Model Technical Advisory Committee (PTAC) on how to best incorporate care coordination into alternative payment models (APMs).

During a presentation to the committee on June 10, Shari Erickson, ACP vice president for governmental affairs and medical practice, discussed how the ACP APM, known as the Medical Neighborhood Model (MNM), would improve care coordination and patient care.

The Medicare Access and CHIP Reauthorization Act of 2015 created the Quality Payment Program, which calls for the creation and development of APMs that provide incentive payments for high-quality and cost-efficient care. The PTAC is charged with making recommendations to the Secretary of the Department of Health and Human Services on proposals that should be pilot-tested by the Centers for Medicare & Medicaid Services Innovation Center. ACP submitted its MNM to PTAC last year, and PTAC supported the ACP recommendation to pilot the model in September 2020. So far, none of the models that PTAC has recommended have been approved for such pilot-testing or implementation.

At the June 10 meeting, ACP, along with other stakeholders, was asked to discuss how its APM would improve care coordination, with a focus on what was learned throughout the COVID-19 pandemic. “Hopefully, CMS is listening to the points we and others raised that were related to how to better incorporate care coordination into all models,” Erickson said.

About the MNM

Developed with the National Committee for Quality Assurance, the MNM includes care coordination between primary care specialists and other specialty physicians. Communication is the heart and soul of the model, and it starts with the referral process, Erickson explained.

The model would help make the referral process more seamless by including pre-consultations between primary care practices and specialty care practices. “The primary care doctor shares all of the relevant information with the specialist and they engage in a Care Coordination Agreement that is available on the ACP website,” Erickson said.

In addition to a sample care coordination agreement, ACP's website also contains a toolkit with core datasets of what should be shared between practices in advance of the first appointment and thereafter. “Ideally, this model reduces the amount of paperwork because the agreements are in place between practices that work together, so there is clarity about what needs to be shared and what needs to be shared back,” Erickson said.

Moreover, everyone sees the ongoing care plan, including the primary care doctor. “Live, direct communication that is built in the least burdensome way possible is rewarded through appropriate payment for subspecialists in this APM,” Erickson said.

The MNM has other benefits that make it appealing. “The medical neighborhood isn't limited to any one clinical condition or specialty,” Erickson said. “It can be implemented across multiple patient populations and specialties.”

ACP members, including subspecialty practice members, should be ready to consider new APMs if and when they become available. To prepare, “explore our Care Coordination Toolkit and feel free to provide any feedback to ACP on it,” Erickson said.

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Back to the June 18, 2021 issue of ACP Advocate