CMA Developing Innovative Alternatives to the Medicare Payment System Based on Successful California Models

The CMA is working to develop a series of alternative payment and delivery models to pilot test through the CMS Innovation Center (CMMI).  These pilots are based on successful California models and can be implemented both by large medical groups and small-practice, independent physicians working together.  The pilot ideas are listed below and can work under a variety of payment models, such as shared-savings, various forms of capitation and fee-for-service: 

• Clinical Variation Reduction and Quality Program facilitated by a California County Medical Society for Independent Physicians in the community  - reviewed and accredited by the CMA Institute for Medical Quality (IMQ).  It would apply a shared savings payment model for participating physicians. 
• Medicare and Medicaid Patient-Centered Medical Home Expansion for Primary Care and Certain Specialties where physicians become the primary treating physician.
• Physician Peer Comparison Education and Shared Savings Program where physicians are compared to their specialty peers in their geographic region and rewarded for meeting certain utilization, quality, hospital admission and other standards set by physicians.
• A Palliative Care Medical Home Project that coordinates care teams of physicians and other institutional and non-institutional providers, including hospice and home health,  to work with patients and their families to meet their wishes and provide palliative end-of-life care in the most respectful way in the most appropriate setting.
• Accountable Care Organization Transition Model that gives solo/small group independent physicians more time and upfront resources to create physician-led, patient-centered organizations that coordinate care and improve the overall quality of care.
• Pilots to Improve Physician Supply and Access to Care in Rural Areas such as an expansion of the J-1 VISA Foreign Physician Program and telemedicine programs, reform of the Health Professional Shortage Area payment system so that physicians in nearby communities will be incented to care for rural patients.