By CMS.GOV | Dec 03, 2020
What is the Geographic Direct Contracting Model?
The Geographic Direct Contracting Model (also known as the “Model” or “Geo”) is a new payment and care delivery model being tested by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The Model will test whether a geographic-based approach to value-based care can improve quality of care and reduce costs for Medicare beneficiaries across an entire geographic region. Leveraging best practices and lessons learned from prior Innovation Center models, Geo will enable Direct Contracting Entities (DCEs) to build integrated relationships with healthcare providers and community organizations in a region to better coordinate care and address the clinical and social needs of Medicare beneficiaries.
DCEs will take responsibility for total cost of care for Medicare Fee for Service (FFS) beneficiaries in a specific region. DCEs will implement region wide care delivery and value-based payment systems with the goal of improving care for beneficiaries through higher quality and lower costs. To achieve these goals, the model will enable DCEs – which may include sophisticated Accountable Care Organizations (ACOs), health systems, health care provider groups, and health plans – the flexibility to utilize a variety of tools described in more detail below.
Geo builds on lessons the CMS Innovation Center has learned from prior Medicare Accountable Care Organization (ACO) initiatives, including the Medicare Shared Savings Program and the Next Generation ACO Model, as well as innovative approaches from Medicare Advantage, Medicaid Managed Care, and commercial health plan risk-sharing arrangements. Geo requires participants to take full risk with 100 percent shared savings / shared losses for Medicare Parts A and B services for aligned Medicare FFS beneficiaries in a defined target region. Geo will be tested over a six-year period in four to ten regions and will include two three-year performance periods, the first of which starts on January 1, 2022 and the second of which starts on January 1, 2025.
What are the goals of the Model?
The goal of Geo is to test whether DCEs are able to improve quality of care and lower costs for Medicare beneficiaries across an entire region. Beneficiaries in the region will maintain all their Original Medicare benefits but may receive enhanced benefits and may have lower (but never higher) out-of-pocket costs for certain services than in Original Medicare. Providers in the region will have the option to enter into value-based payment arrangements with DCEs. Health care providers that choose not to enter into an arrangement with a DCE will continue to be reimbursed at 100% Medicare FFS rates.
Categories: DPC News