As we approach another Medicare ACO performance year (now in the ACO REACH model, following the sunset of Direct Contracting), we are providing a revised overview of Primary Care Capitation (PCC) in an easy-to-understand format. We encourage all new and returning Participant Providers to read this blog post to ensure they’re ready to hit the ground running in 2023.
For many primary care providers (PCPs), managing traditional Medicare fee-for-service (FFS) patients under a CMS-calculated budget is value-based care in its simplest form. The ACO REACH (ACO) Model builds upon this basic structure and introduces a mechanism to provide PCPs with increased revenue stability and more predictable cash flow for their aligned Medicare patients: Base Primary Care Capitation (BPCC).
If you’re a PCP joining a REACH ACO in 2023, there is a lot to learn about how capitation will impact your monthly revenue in advance of the January 1st start date. In this post, we will address providers’ most Frequently Asked Questions regarding BPCC.
Note: Capitation is the remittance to providers of a stable reimbursement that is not directly tied to the volume of healthcare services provided. In other words, rather than receiving compensation for each patient visit or procedure (fee for service), providers get a set reimbursement based on their assigned population. For a quick refresher on the various forms of capitation in ACO REACH (previously Direct Contracting), read this overview.
For more help unpacking how Medicare’s ACO REACH model works, check out these resources. Follow Pearl Health on LinkedIn or Twitter for regular insights in your newsfeed.
