Cms Unveils Highly Anticipated Geographic Direct-Contracting Model

Rising health spending and the pressures of the recent pandemic have contributed to the development of a new type of competence centre (COE), called Future-State-COE, designed to better meet the needs of large employers. This WCC model integrates value-based contracts and strong incentive design into a service line strategy to create employee health programs that benefit employers, patients and providers. “This model allows participating companies to build integrated relationships with healthcare providers and invest in the health of the population in a region to better coordinate care, improve quality and reduce the costs of care for Medicare recipients in a community,” said Seema Verma, CMS administrator, in a press release. In a recent call with healthcare stakeholders, leaders at the Center for Medicare & Medicaid Innovation heard various ideas to improve value-based payment models. “The need to strengthen the Medicare program by moving to a system that aligns financial incentives to pay for people`s health has long been a priority,” said Seema Verma, CMS administrator. “This model allows participating companies to build integrated relationships with health care providers and invest in the health of a region`s population to better coordinate care, improve quality and reduce the cost of care for Medicare beneficiaries in a community.” This model aims to improve quality and reduce costs for Medicare recipients across an entire region. For the geomodel, cmS defines a region as a Core Statistical Area (CBSA). CMS aims to have a minimum of 3 direct contracting entities (SPAs) per region and a maximum of 7 depending on the volume of FFS beneficiaries.1 “The geographic direct procurement model is part of the Innovation Centre`s direct procurement models and one of the Centre`s largest bets on value-based supply to date”, said Brad Smith, Director of CMMI. The model provides participants with flexibility and improved tools to improve care for Medicare recipients in a region, while providing recipients with better benefits and the opportunity to reduce personal expenses. By initially testing the model in a small number of regions, we will be able to learn carefully how these flexibilities can affect quality and cost. While global and professional DC models (as well as many other models) require a company to assume financial risk for a group of beneficiaries who see a specific group of providers, this model requires the company to take a financial risk on a portion of the beneficiaries of those physicians who are located in a particular geographic area. It is clear that CMS is interested in testing and understanding how a geographic approach can improve value-based maintenance with the release of the geomodel as well as the release of the CHART model.

The 3. In December 2020, the Centers for Medicare & Medicaid Services (CMS) officially announced the release of the Geographic Direct Contracting Model (Geo), a highly anticipated option introduced at the start of the Direct Contracting program but subject to requests for additional information. We share the industry`s enthusiasm for the model and appreciate the detailed approach to align and clarify the additional benefits. “What we hope is that the supplier entities . find value-based payment arrangements that build on and leverage existing CMMI payment models,” Brad Smith, Assistant Administrator and Director of the Innovation Center, said in an interview. The new tools are “a very significant change from all other models,” Verma said. “It`s really. the next generation of CMMI models. Lead organizations, known as direct contracting entities (LCC), coordinate procurement with local suppliers through their own risk-sharing agreements. ELDs should have “significant experience of risk-taking in value-based models of care” and may be responsible care organizations (COAs), health systems, groups of health care providers, or health care plans, according to a CMS fact sheet. ELDs can also be partnerships between health care plans and providers. Smith said the agency was “very thoughtful in considering how Geo overlaps with other value-based payments.” All Geo participants and beneficiaries are eligible to participate in all other value-based models of care at the Innovation Center.

According to Smith, payments made under the Medicare Shared Savings Program or other CMS payment models are billed by geographic unit and taken into account when calculating their collective savings. “The model has seven quality measures designed to reduce burden on providers, all of which are consistent with existing quality measures and ACO programs or the Medicare Advantage Star program,” Smith said. Specifically, model participants coordinate care and clinical management for original Medicare beneficiaries in their region. This coordination may include care management and telemedicine services, as well as helping beneficiaries understand which providers have achieved better results and reduced long-term costs in the past. A third option in the Medicare direct contracting model was recently announced in the run-up to the launch of the first two versions in the spring. Suppliers will receive the same refund they have unless they sign a contract that changes that, Verma said. The agency is investigating whether direct contractors could take on the capitulation for non-preferred suppliers if they meet certain requirements. .

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