CMS has unveiled a new model that aims to address chronic disease, behavioral health and other medical conditions to promote health equity, increase access to primary care services, set health expenditures on a more sustainable trajectory and lower costs for patients.
The new model is the next iteration of CMS' multi-payer total cost of care models, according to a Sept. 5 press release sent to Becker's.
Participating states will be accountable for quality and population health outcomes while reducing all-payer avoidable healthcare spending.
CMS will partner with states to redesign healthcare delivery to improve total population health. CMS hopes to strengthen primary care for those with Medicare and Medicaid.
CMS plans to begin its new model with eight selected states; each one will receive up to $12 million from CMS to support implementation.
The model performance period for states is scheduled to begin in January 2026 or January 2027, depending on the cohort, and the model will conclude for all state participants in December 2034.
The model will do four specific things for states:
1. It will focus resources and investment on primary care services, giving primary care practices the ability to improve care management and better address chronic disease, behavioral health and other conditions.
2. It will provide hospitals with a prospective payment stream via hospital global budgets, while including incentives to improve beneficiaries' population health and equity outcomes.
3. It will address healthcare disparities through stronger coordination across healthcare providers, payers and community organizations in participating states or regions.
4. It will address the needs of individuals with Medicare and/or Medicaid by increased screening and referrals to community resources like housing and transportation.