CMS Direct Contracting is coming fast, is very nuanced, and full of grey. In a nutshell, 50% of Medicare patients are in Medicare Advantage (i.e., value-based care) and 50% are still Medicare fee-for-service (FFS). Direct Contracting is CMS’ bold play to quickly move many of the remaining Medicare fee-for-service (FFS) patients into value based care.
If you’re a doctor who takes care of Medicare fee-for-service (FFS) patients, then it is going to affect you whether you’re paying attention or not. That’s doubly true if you’re in one of the 10 “Geo” model regions (Atlanta, Dallas, Houston, Los Angeles, Miami, Orlando, Philadelphia, Phoenix, San Diego, Tampa). In those regions, 100% of non-Medicare Advantage beneficiaries will have to align with one of three to seven awarded Direct Contracting Entities (DCE). DCE applications are due April 1, 2021 and all beneficiaries will be re-aligned under this fully capitated plan beginning January 1, 2022. Ya… that fast.
“There will no longer be any fee for service for all of Medicare and all of dual eligibles, which is Medicaid and Medicare eligible, in up to 10 regions of our country starting the first of next year.” Gail Zahtz, Founder and CEO, WiseCare
Today we’re talking with Gail Zahtz, Founder and Chief Executive Officer at WiseCare, a startup applying to become a Direct Contracting Entity (DCE). Gail helps us to understand the urgency of the situation and walks us through the nuance of the model. And while she acknowledges the hurdles for providers, and the risks CMS’ rapid timeline imposes, she also embraces the opportunity that Direct Contracting represents. As a cancer survivor, Gail understands firsthand the difficulty of navigating our healthcare system and she believes Direct Contracting offers a pathway to really make a difference in how care is delivered. It makes new services and care models possible, and it allows doctors to care for patients in the way they dreamed of when they got into medicine.
Direct Contracting / Direct Contracting Entity (DCE) Topics Covered
- What is Direct Contracting and how does it differ from MSSP and Next Gen ACO models?
- What are the timelines?
- What are the different types of Direct Contracting Models?
- How are beneficiaries aligned to DCEs?
- Do patients have a choice in any of this?
- How will patients’ benefits and/or costs change?
- What will happen to doctors who ignore this and let the pieces fall where they may?
- How do doctors interact with DCEs?
- How does payment flow through the DCEs?
- How can doctors find the DCEs in their area who they might partner with?
- How should providers evaluate DCEs to determine if they are right for their patients and their business?
- How does quality measurement work in Direct Contracting?
- Will there be any changes to the model under the Biden Administration?
There’s a lot here, and still a lot of open questions on Direct Contracting. We’re going to do our best to unravel this for you in the coming weeks. Drop me a note at don@thehcbiz.com and let me know what questions you’d like us to cover.
For more on Direct Contracting check out
Episode 158: Direct Contracting: A Physician’s Perspective with Dr. Krishnan Narasimhan
For more on Value-based Payment Models, check out our 5-part series with Gail Zahtz
Everything You Need to Know About Value-Based Payment Models to Prepare for 2022
Gail Zahtz
Founder and Chief Executive Officer, WiseCare Inc.
Gail Zahtz has spent her career focusing on the intersection of evidence-based healthcare and user-centric design to honor and empower the doctor-patient relationship. An entrepreneur since the 1990s when she took a health-in-the-workplace property to $100M valuation, she has served as an adviser to healthcare start-up funders, a thought leader and advisor to industry on designing for health outcomes, a consultant to health innovation startups, and the architect of value-base healthcare delivery for NY’s largest post-acute healthcare system. She has won numerous awards for her work at the intersection of health and design, including: Top 100 in Health Info Technology, Top 100 International Influencers in Health, and Top 50 Most Influential Health Leaders. As a survivor of late-stage cancer and domestic violence, Gail is dedicated to sharing her story of how to survive and thrive in the most challenging of circumstance to show young women everywhere a way forward.
Twitter: https://twitter.com/GailZahtz
LinkedIn: https://www.linkedin.com/in/gailzahtz/
About WiseCare
WiseCare is an Integrated Healthcare Collaboration Company, enabling doctors to deliver true wrap-around care to Medicare patients by leveraging the new value-based care models. WiseCare makes thriving within the new capitated models seamless for physician practices and alternate-level-of-care facilities. A partner, not just a payor, we offer the ready-made collaborations and working partnerships across the healthcare continuum that will be the key to success. And we’re expert in helping physicians keep, grow, and better care for their Medicare populations in this fast-changing environment. We lessen administrative burdens, improve financial stability, provide the data physicians need to make strategic care decisions, and deliver benefit enhancements that pay off for patient and caregiver, physician, and the practice. And our CareCoaches support patients and care plans between office visits, providing: condition and wellness education, targeted referrals to medical and social providers, and resolution of issues that stand between your patients and better outcomes.
That’s what we call Healthcare Made Well. To learn more about how WiseCare can partner with you, email us at info@wisecare.health.
Web: https://www.wisecare.health/
LinkedIn: https://www.linkedin.com/company/wisecare-health/
Links and Resources
- Notice of DCEs Participating in the Implementation Period of the Direct Contracting Model, Global and Professional Options This is dated, and only covers the Global and Professional options, but is worth a look if you’re trying to figure out what’s happening in your area.
- CMS Announcement: Geographic Direct Contracting Model (“Geo”)
- CMS Direct Contracting Model Options
- Industry Voices—CMMI chief: Direct Contracting Geographic Model a win for all stakeholders
- ACOs press for halt to Geographic Direct Contracting model due to complexity concerns
- ACOs Fear Direct Contracting Options Stray Too Far From Providers
Listen to the Direct Contracting interview with Gail Zahtz right here:
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