CMS overhauls Direct Contracting model to include new requirements on governance, health equity in 2023

February 24, 2022acoACO, ACOs, direct contracting

The Biden administration is redesigning the controversial Direct Contracting Model to add new requirements to tackle health equity and ease progressive lawmakers’ concerns over the role of private equity. The Centers for Medicare & Medicaid Services (CMS) announced Thursday that the professional and global Direct Contracting Model will transition in 2023 to the Accountable Care…

NAACOS, APG Urge HHS to Adjust Direct Contracting Model, Not Cancel

February 16, 2022acoAMA, APMs, CMMI, congress, DCEs, direct contracting, FFS, HHS, NAACOS

More than 200 healthcare organizations, including America’s Physician Groups (APG) and the National Association of ACOs (NAACOS), have urged the Department of Health and Human Services (HHS) to make adjustments to the Global and Professional Direct Contracting Model instead of canceling the program. In a letter to HHS Secretary Xavier Becerra, the groups stressed that shutting down the Direct…

Healthcare Groups Plead with HHS’ Becerra to Retain Direct Contracting Model

February 15, 2022acoBecerra, DCEs, direct contracting, HHS

A large group of 222 healthcare organizations, both national healthcare associations and provider organizations, including accountable care organizations (ACOs), sent a letter on Monday, February 14, to Health and Human Services Secretary Xavier Becerra, urging him not to cancel the Global and Professional Direct Contracting (GPDC) model, but instead make adjustments to it. Among the…

Provider Collaboration Needed to Drive Patient Experience, ACO Success

February 9, 2022acoAPMs, direct contracting, FFS, Interoperability, provider collaboration

In order to ensure accountable care organization (ACO) and patient experience success, providers must collaborate across the continuum of care, suggested a recent study out of the Ohio State University Fisher College of Business. “We found that if an ACO wants to be successful, it needs representation across all parts of a patient’s continuum of care,”…

Over 50 Lawmakers Urge Administration to End Direct Contracting

January 17, 2022acoAMA, APMs, CMMI, congress, DCEs, direct contracting, FFS, HHS, NAACOS

The lawmakers claim direct contracting is a Trump-era privatization tactic that has removed millions of seniors from Traditional Medicare without their knowledge or consent. More than 50 lawmakers led by US Representative Pramila Jayapa urged the Biden administration to discontinue the Medicare Direct Contracting (DC) program and transition Medicare beneficiaries into the Traditional Medicare model. In a letter written to HHS…

Medicare Direct Contracting Demo Garners Critics and Defenders

January 4, 2022acoaccountable care, accountable care organizations, ACOs, direct contracting, Medicare

As the Biden administration continues to move Medicare reimbursement from volume-based payment to payments based on value, officials are expanding those efforts to include providers who care for “traditional” Medicare patients and currently bill under a fee-for-service system. The new Direct Contracting program, a demonstration program that began under the Trump administration, allows “a broad…

Has a New Policy Fault Line Opened Up Around APMs?

October 4, 2021Garrett SchmittNo CommentsACO, ACOs, alternative payment models, America's Physician Groups, APG, APMs, direct contracting, Medicare, Medicare Advantage, MSSP

As we reported in a news article on Sept. 30, “A dispute has arisen over controversial statements made by two prominent healthcare policy leaders around the Medicare Advantage program. On Sept. 30, Donald Berwick, M.D., and Richard Gilfillan, M.D., published an article in the Health Affairs Blog entitled “Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2:…

Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2: Building On The ACO Model

September 30, 2021Garrett SchmittNo Commentsdirect contracting, Medicare, Medicare Advantage, MSOs, PCPs, Risk, SPACs

Given an Orwellian title, Direct Contracting, launched by Center for Medicare and Medicaid Innovation (CMMI), was anything but direct. “Indirect Contracting” would have been a far more accurate name, since the cornerstone of the program was CMS’s opening the door to non-provider-controlled “Direct Contracting Entities (DCEs)” to become the fiscal intermediaries between patients and providers….

Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 1: The Risk-Score Game

September 29, 2021Garrett SchmittNo Commentsdirect contracting, Medicare, Medicare Advantage, MSOs, PCPs, Risk, SPACs

While the COVID-19 pandemic rages, the past two years have seen another epidemic of a far different type—in financing and acquisitions of firms focused on serving Medicare beneficiaries. These firms include physician practices, notably primary care practices (PCPs); management services organizations (MSOs) that aggregate practices; and Medicare Advantage (MA) insurers. In this arena, the combined…

Direct Contracting Opens a New Door for SNFs in Value-Based Care

July 5, 2021Garrett SchmittNo CommentsCMS, DCEs, direct contracting, SNFs, value-based care, vbc

Institutional special needs plans (I-SNPs) are seen by some to be the only path forward for skilled nursing facilities (SNFs) to enter value-based care, however, Brian Fuller, CEO of care coordination company Integrated Care Solutions (ICS), thinks SNFs should get more involved with direct contracting entities (DCEs). A lack of understanding may be preventing them…

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