Centers for Medicare and Medicaid Services announces 51 direct contracting entities


The Heart for Medicare and Medicaid Innovation has introduced that 51 supplier and accountable care organizations are taking part in direct contracting, the brand new danger mannequin that has developed from Subsequent Technology.

The implementation interval, which started in October and runs by way of March 31, 2021, offers time for the direct contracting entities to arrange for the primary efficiency yr which begins on April 1, 2021. Organizations want to enroll beneficiaries, construct a historical past of claims knowledge, and set up care coordination practices earlier than monetary accountability begins in April.

The 51 direct contracting entities serve beneficiaries in 39 states in addition to within the District of Columbia and Puerto Rico.

Direct contracting is the following accountable care mannequin from the CMS Innovation Heart. So far, Subsequent Technology has been the ACO of highest danger and reward.

The Subsequent Technology accountable care group mannequin was initially scheduled to sundown on the finish of this yr after a five-year run. CMS gave the mannequin an extension to the top of December 2021, after quite a few organizations requested that the deadline be moved as a result of challenges attributable to the COVID-19 pandemic.

There will likely be extra alternatives for organizations to hitch the direct contracting mannequin, together with a 2022 start-date, after the Subsequent Technology ACO mannequin ends.

WHY THIS MATTERS

Direct contracting is a voluntary, five-year various fee mannequin aimed toward lowering expenditures for Medicare fee-for-service beneficiaries.

CMMI aimed to encourage participation for a broad vary of organizations and doctor practices that haven’t usually participated in different CMMI fashions.

Direct contracting builds upon classes discovered from the Medicare Shared Financial savings Program and the Subsequent Technology ACO mannequin. It additionally leverages progressive approaches from Medicare Benefit and personal sector risk-sharing preparations, CMS mentioned.

Danger-sharing fee mannequin choices embody the decrease risk-sharing association of 50% financial savings and losses and has major care capitation, a capitated, risk-adjusted month-to-month fee for enhanced major care providers.

The worldwide possibility provides the best danger sharing association of 100% financial savings and losses and offers two fee choices: the first care capitation of the primary possibility or whole care capitation, which is capitated, risk-adjusted month-to-month fee for all providers offered.

The mannequin has three kinds of individuals: Customary, which consists of organizations that typically have expertise serving Medicare FFS beneficiaries and should have beforehand participated in Subsequent Technology, Pioneer or MSSP; new entrants; and excessive wants inhabitants direct contracting entities.

The latter serve Medicare FFS beneficiaries with complicated wants, together with dually-eligible beneficiaries.

CFO Kevin J. Conroy, CFO and chief population health officer at CareMount Well being Options in New York mentioned the doctor group has lengthy participated in value-based applications utilizing inhabitants well being analytics and has seen a lot success within the Subsequent Gen program.

CareMount invested closely in infrastructure and expertise for value-based care, Conroy mentioned. Years in the past it made the choice to put money into analytics and a tech platform for in-house inhabitants well being.

“We’re knee dip within the street to worth,” Conroy mentioned. “We’re making an attempt to construct an built-in community of suppliers.”

Greater than midway by way of the yr, telehealth has confirmed to achieve success.Physicians had 1,600 to 1,700 televisits every week through the top of the pandemic in New York Metropolis.

“We’re again all the way down to 95% of in-person exercise,” Conroy mentioned. “Telemedicine has dropped all the way down to 250 visits every week.”

For direct contracting, it’s going into the capitation association. The important thing right here is across the benchmark when 2020 cannot be thought of a traditional yr, he mentioned.

CareMount is a doctor’s apply ACO that, like many suppliers and particularly being in New York Metropolis, needed to alter whereas the COVID-19 pandemic surged within the space.
Final month, CMS launched extra data on the monetary facets of the mannequin.

THE LARGER TREND

Well being methods which have finest weathered COVID-19 are those who have moved from fee-for-service to worth, Conroy mentioned. It’s because, by way of a capitation mannequin there are monetary preparations no matter utilization, whereas fee-for-service relies on utilization, with no income coming in through the top of the pandemic when all elective procedures had been postponed.

ON THE RECORD

“This preliminary direct contracting cohort demonstrates sturdy curiosity on this new mannequin,” NAACOS mentioned. “These preliminary individuals needs to be counseled for his or her dedication to enhancing the standard of look after Medicare sufferers whereas decreasing spending.”

Twitter: @SusanJMorse
E-mail the author: susan.morse@himssmedia.com



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