Currently only five payment models qualify as Advanced APMs.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) creates two payment tracks for Medicare Part B services – Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS). MACRA narrowly defines Advanced APMs as those that accept both risk and reward for providing coordinated, high-quality, and efficient care. Currently only five CMS payment models qualify as Advanced APMs (see image to right), which includes approximately 10% of eligible clinicians. These clinicians are considered Qualifying APM Professionals (QPs) if they also meet other “level of participation” criteria including quality measurement comparable to MIPS and the use of EHRs.
MACRA does not change how each particular APM measures and rewards success within its design. Rather, it rewards a substantial degree of participation in certain APMs. Eligible clinicians who are QPs are excluded from the MIPS. For 2019 through 2024, QPs receive a lump sum incentive payment equal to 5% of their prior year’s payments for Part B covered professional services, and beginning in 2026, QPs receive a higher update under the PFS than non-QPs.
The success of an Advanced APM hinges on its ability to control the cost and quality of all medical care delivered to attributed patients. This requires primary care to truly function as the quarterback, coordinating care across the community. Infina Connect’s Intelligent Care Coordinator (ICC) puts primary care in the drivers seat, enabling better coordination and ongoing visibility into the status of their patients. With ICC you can:
Impact cost/utilization and quality measure performance.
Optimize placement of referrals within high value and owned provider networks.
Expedite the referral process & prevent avoidable hospital admissions.
Manage cost by referring to high value partners.
Regardless of the consulting providers EHR.
Electronically exchange C-CDA’s or other clinical documents.
Manage quality with ongoing visibility into patient care.
Coordinate care community wide.
Receive clinical summary & results electronically.