DCE Geographic Model to Include Medicare MCOs, Dually Eligible Patients

Last week, the Center for Medicare and Medicaid Innovation (CMMI) announced the Geographic track for the Direct Contracting model. This week, the Centers for Medicare and Medicaid Services (CMS) expounded on the program, announcing that the model could be extended to Medicare Managed Care Organizations (MCOs) serving dually eligible beneficiaries.

CMMI developed the Direct Contracting Model Professional And Global options for the first round of applications, the goal of which is to test the financial risk-sharing arrangements for Medicare and offering improved quality of care to traditional Medicare beneficiaries. The Geographic model includes opportunities for MCOs to coordinate care for dually eligible enrollees.

The Geographic model relies on providers in specific regions to leverage existing relationships in order to create care delivery solutions that account for the entire region’s patients. This will come in the form of performance benchmarks that providers must meet in order to access savings through the program. The benchmark is tied to the fee-for-service spending in the region.

The Direct Contracting Model will test if MCOs or their corporate affiliates can be held accountable for patient health outcomes for fully dually-eligible enrollees in addition to the risk that Medicaid MCOs already have under Medicaid, according to the CMS factsheet.

From CMS Administrator Seema Verma, in the press release announcing the model:

Beneficiaries eligible for both Medicare and Medicaid are some of our most vulnerable neighbors and friends, and the COVID-19 pandemic has made this abundantly clear as this population had some of the highest rates of hospitalizations for COVID-19… [this model] represents a significant step toward addressing these longstanding issues and ensuring they receive the coordinated care they rightfully deserve.

Becker’s Hospital Review reports that this is the first payment model opportunity that assists MCOs coordinate care for dually-eligible beneficiaries.

However, the National Association of ACOs (NAACOS), is calling for CMS to cool it on the payment model overall. NAACOS wrote a letter to CMMI stating that the Geographic Direct Contracting model needs further testing and could potentially cause patient confusion, according to Fierce Healthcare. From the letter:

This could disrupt existing care relationships and potentially create waste in a healthcare system at a time when resources are already stretched thin as we recover from the COVID-19 pandemic. Rather than adding a new layer of complexity that introduces even more confusion about the overlap, we request the innovation center focus on fixing the existing model overlap issues.

The first period for the Geographic model will run from January 1, 2022 to December 31, 2024 and the second period will take applications in 2024 and run from the beginning of 2025 through 2027.