An Alternative Payment Model (APM) is a new approach to paying for medical care that financially rewards clinicians for delivering high-quality, cost-effective care.
- In 2023 FR, CMS made significant changes to the MSSP including the introduction of Advance Investment Payments (AIPs) for new, low revenue ACOs joining the BASIC track of MSSP (Jan 1, 2024, start date). This program will consist of a $250,000 one-time up-front payment, then quarterly payments. Beginning in 2024, ACOs inexperienced with performance-based risk can participate for 5 years in a one-sided model. The previous gap year for the 5 percent APM incentive payment, Payment Year 2025, has been eliminated with the one-year extension to the APM incentive payment (granted with the passage of the 2022 Consolidated Appropriations Act, 12/23/22).
- Note: The incentive payment was reduced to 3.5 percent for PY 2025. For PY 2026 and beyond, payment rates under the Medicare PFS for services furnished by the eligible clinician will be updated by a new APM conversion factor.
- Beginning with Payment Year 2025, the QP Threshold will Increase to 75% for payment amount, and 50% for patient count.
- The Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model will increase access to accountable care in underserved communities and will have 824 Federally Qualified Health Centers, Rural Health Centers, and Critical Access Hospitals.
- Medicare Shared Savings Program (MSSO) Accountable Care Organizations (ACOs) can continue reporting quality data through the CMS Web Interface through the 2024 performance year. In 2025, they will have to report all-payer quality data on three eCQMs/MIPS CQMs via the APM Performance Pathway (APP).
- CMS introduced a new reporting framework for MIPS Alternative Payment Models (APMs) and Accountable Care Organizations (ACOs) called the APM Performance Pathway (APP). The APP is a single, pre-determined measure set that MIPS APM participants may choose to report on beginning in the 2021 performance year.
Primary Cares Initiative
On April 22, 2019, CMS announced its Primary Cares Initiative, which includes two new APMs intended to transform primary care. For more information on the new models and how to apply, click on the respective ACP fact sheets below. Please note that as more information is made available, ACP will update these fact sheets and develop other educational resources.
- Primary Care First Model Webinar with CMS Staff (Member Login Required)
- Primary Care First: Frequently Asked Questions (Member Login Required)
- ACP Primary Care First (PCF) Fact Sheet
- ACP's Direct Contracting (DC) Model Fact Sheet
Read more about ACP's APM and QPP related advocacy efforts
What is an Advanced APM (AAPM)?
Advanced APMs (AAPMs) is a term used to designate a smaller group of select APMs that meet advanced risk, quality, and technology requirements. Clinicians who significantly participate in AAPMs enter a separate “track” under the Quality Payment Program (QPP) that excludes them from participating in MIPS and awards them certain incentives, including a 5% bonus.
Note: Clinicians who participate in APMs that do not qualify as AAPMs may receive special scoring under MIPS through the APM scoring standard. Visit our MIPS page to learn more.
Medicare Advanced APMs at a Glance
* For application related deadlines for all of the models visit ACP’s Physician & Practice Timeline
Primary Care First (PCF)
Primary Care First (PCF) is a voluntary, multi-payer, five-year model operating in 26 regions of the country that offers enhanced payments to support advanced primary care services. Practices can receive performance-based payments in addition to a combination of a flat primary care visit fee and a population-based payment (PBP) that is calculated using the complexity of the patient population. Primary Care First includes two cohorts of participating practices: Cohort 1 began in January 2021 and Cohort 2 started in January 2022. There are currently 2,600 practices participating in both cohorts, and 22 payer partners. Additional resources can be found below:
ACO REACH/The Direct Contracting Model
The redesigned Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, previously known as The Global and Professional Direct Contracting Model has three main priorities:
- Advance health equity to bring the benefits of accountable care to underserved communities
- Promote provider leadership and governance
- Protect beneficiaries and the model with more participant vetting, monitoring, and greater transparency
The Global and Professional Direct Contracting Model is a voluntary, five-year ACO model that started on April 1, 2021, and became the ACO REACH Model in 2023. This model currently offers partially or fully capitated payments for relevant Medicare Part A and Part B services and features two distinct tracks; 1) the Professional Option, which is 50% shared savings/losses and primary care capitation; and 2) the Global Option, which is 100% shared savings/losses and primary care or total care capitation. There are currently 132 ACOs participating in PY2023 of the ACO REACH Model. Check out the ACO REACH Model Fact Sheet for more information on the current requirements.
The Kidney Care Choices (KCC) Model
The Kidney Care Choices (KCC) Model builds on the existing ESRD Care Model structure, in which dialysis facilities, nephrologists, and other clinicians form ESRD-focused ACOs to manage care for beneficiaries with ESRD. This model adds fixed payments for clinicians who manage care for Medicare beneficiaries with late-stage chronic kidney disease and ESRD. The goal is to delay the onset of dialysis and incentivize kidney transplantation. The model will have four distinct payment Options: the CMS Kidney Care First Option and the Comprehensive Kidney Care Contracting Graduated, Professional, and Global Options. The KCC Model Performance Period began on January 1, 2022, and will continue through December 31, 2026. CMS began solicitating applications for a second cohort of KCC Model participants which ended March 25, 2022. This cohort began on January 1, 2023. CMS does not plan to conduct any further solicitations for KCC Model participants. Subscribe to the KCC listserv to receive updates specifically regarding the KCC Model.
The Medicare Community Health Access and Rural Transformation (CHART) Model
The Medicare Community Health Access and Rural Transformation (CHART) Model offers up front funding for innovation in rural communities. It features the "Community Transformation Track” for new networks of community partners led by a Lead Organization, that represents a rural Community, comprised of either a single county or census tract or a set of contiguous or non-contiguous counties or census tracts. In 2021, CMS awarded cooperative agreement to four entities under the CHART Community Transformation Track. These four Lead Organizations are expected to coordinate efforts across the community to ensure that access to care is maintained and various stakeholders are understood and accounted for in the transformation plan. Due to insufficient participation from rural health hospitals to proceed with the first Implementation Year of the CHART Model in 2023, CMS is determining the next steps for the model while working with rural health experts and participating Lead Organizations. Find more information here.
Comprehensive Primary Care Plus (CPC+)
Comprehensive Primary Care Plus (CPC+), was a five-year, multi-payer program, began in January 2017 with the aims of improving quality, access, and efficiency of primary care. The program comprises 2,610 primary care practices in 18 regions with two primary care practice tracks. Practices are supported by 52 aligned payers, from whom they receive additional payment outside of the fee-for-service system for providing comprehensive primary care. This program ended on December 31, 2021, and participating practices are invited to participate in another CMMI model, if they are able to do so. Other model options include Primary Care First, the Direct Contracting Model, and/or the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). Additional CPC+ resources can be found below.
- CMS’ CPC+ Website
- ACP’s Joint Letter with AAFP - Recommendations on Improving the PCF Model
Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model
The Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model is a voluntary value-based payment model that started on October 1, 2018, that aims to support healthcare providers who invest in practice innovation and care redesign to better coordinate care and reduce expenditures. This model supports CMS and CMMI continuing efforts in implementing voluntary episode payment models to improve the quality of care for Medicare beneficiaries. The BPCI Advanced Model was set to end on December 31, 2023, and will now conclude on December 31, 2025. The Request for Applications (RFA) for Medicare-enrolled providers, suppliers, or ACOs to start participation in the Model on January 1, 2024 (Model Year 7) is open. The application portal opened on February 21, 2023, and will stay open for 100 days and close on May 31, 2023.
More on Advanced APMs
1. What models currently qualify as Advanced APMs?
Click here for a full list of qualifying 2023 Advanced APMs, including Medicare Advantage and private payer models.
2. How do I become a Qualifying Advanced APM Participant (QP)?
To be considered a QP for a given performance year, an eligible clinician must have a certain portion of their patients or payments flow through Advanced APMs. The 2021-2023 thresholds are listed below. Clinicians may qualify based on their participation in Medicare AAPMs alone or based on their combined participation in Medicare, Medicare Advantage, Medicaid, private payer, and multi-payer APMs. Clinicians will have three opportunities to qualify each year based on three overlapping “snapshots” of claims data from January-March, January-June, and January-August. To find out whether you are considered an eligible professional and satisfy the QP thresholds for a given year, visit CMS’ QPP Participation Status Lookup Tool.
2023 Medicare Threshold Option
3. What is a Partial QP?
Clinicians who participate in Advanced APMs but fall short of the QP threshold may reach a separate, smaller threshold and qualify as a Partial QP. Partial QPs have the option to opt out of MIPS. APM- participating clinicians who do choose to participate in MIPS will be scored under the MIPS APM Performance Pathway. Partial QP determinations are made at the APM Entity level. If a clinician opts out of MIPS, it will apply to all of their TIN/NPI combinations.
4. What rewards do clinicians who participate in AAPMs receive?
MIPS eligible clinicians who achieve QP status in Advanced APMs will:
- Receive supplemental or performance-based payments according to the rules established under their APM (e.g., care coordination or infrastructure payments, shared savings, bundled payments, etc.);
- Be exempted from participating in MIPS;
- Receive a 5% lump sum bonus payment on their fee-for-service reimbursements through the 2024 payment years (based on 2022 performance).
- Receive a 0.5% higher Physician Fee Schedule update starting in 2026 (0.75% instead of 0.25%).
- The "Medical Neighborhood" - Advanced Alternative Payment Model (AAPM) Proposal
- Primary Care First Model Webinar with CMS Staff (ACP Member login required)
- Primary Care First: Frequently Asked Questions (ACP Member login required)
- ACP Primary Care First (PCF) Fact Sheet
- ACP’s 2023 Medicare Physician Fee Schedule/QPP Final Rule Summary (ACP Member login required)
- Direct Contracting (DC) Model Fact Sheet
- ACP Advocacy on QPP
- Visit ACP's COVID-19 advocacy page for the latest on what ACP is doing to protect and provide relief for clinicians during these uniquely challenging circumstances.
- AAPMs Overview Page
- QPP Participation Status Lookup Tool
- Qualified AAPM Participant (QP) Methodology Fact Sheet
- QPP Resource Library
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