Associations React to CMS’s Announcement of the New Direct Contracting Models
On Monday evening, national healthcare associations began to issue public statements regarding the release on Monday, Nov. 25 by the Centers for Medicare & Medicaid Services (CMS) of details of the new contracting models that it will open to physician participation in exactly one year, on Nov. 25, 2020.
As CMS officials had announced on Monday, ““Direct Contracting creates a new opportunity for the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) to test an array of financial risk-sharing arrangements to reduce Medicare expenditures while preserving or enhancing the quality of care furnished to beneficiaries. Direct Contracting leverages lessons learned from other Medicare Accountable Care Organization (ACO) initiatives, such as the Medicare Shared Savings Program and the Next Generation ACO (NGACO) Model, as well as innovative approaches from Medicare Advantage (MA) and private sector risk-sharing arrangements. This model is part of a strategy by the CMS Innovation Center to use the redesign of primary care as a platform to drive broader health care delivery system reform.”
Senior executives of both the Los Angeles-based America’s Physician Groups (APG) and the Charlotte-based Premier Inc., and NAACOS, the Washington, D.C.-based National Association of ACOs (accountable care organizations), released statements on Monday evening.
“We are extremely pleased with the Center for Medicare and Medicaid Innovation (CMMI) releasing today the Request for Applications (RFA) for the Professional and Global options of the Direct Contracting Models,” said Donald Crane, the president and CEO of APG, in a statement. “This is yet another step by CMMI in affirming its commitment to ensuring that patients have access to the high-quality, accountable, and coordinated care physician groups have been providing for decades.”
Further, Crane said in the APG statement, “We also applaud CMMI [the federal Center for Medicare & Medicaid Innovation] for reopening the Letter of Intent (LOI) submissions period until December 10, 2019 for the organizations that didn’t submit in August. It is important to note that a LOI must be submitted in order to submit an application, but the LOI is not binding. Risk-sharing arrangements properly incentivize physicians to provide high-value, high-quality healthcare to the patients and communities they serve. We look forward to continuing to work with CMMI to put more tools in the toolbox to help physicians who are moving from volume to value.”
Meanwhile, Blair Childs, senior vice president of public affairs at Premier, said in a statement, “Premier is encouraged by the release of the direct contracting model, which has a number of elements for which we’ve advocated over the years. This includes allowing primary care capitation using Medicare Advantage rates in the regional benchmark and global budgets for providers who are ready for greater risk. We’re also encouraged that the models will provide a quality bonus, coordinate with PACE and Medicaid and focus on care for complex patients. We look forward to working with our members to implement this model, which could offer providers an offramp from the fee-for-service treadmill,” he added.
Meanwhile, another statement was released Monday by the Washington, D.C.-based National Association of ACOs (NAACOS), and attributed to Clif Gaus, Sc.D., NAACOS’s president and CEO. Dr. Gaus said, “The Innovation Center’s Direct Contracting Model is really an ACO by another name and builds off the successful Next Generation (Next Gen) ACO Model. NAACOS is excited to see CMS demonstrating its commitment to value-based care and payment by moving forward with accountable care models like Direct Contracting, which make providers accountable for patients’ total cost of care. Given the robust attention ACOs and the broader health community have given Direct Contracting, NAACOS looks forward to better understanding important details of the program released today.”
Dr. Gaus continued, “NAACOS is pleased to see CMS give Next Gen ACOs the option to continue in the program until it sunsets at the end of next year. Also, allowing two application periods, with the second opening this spring, will allow more time for the provider community to understand important details of Direct Contracting and weigh their participation options. The Professional Option should test a more gradual onramp to fully capitated payment under the Global Option and includes an innovative, 7 percent Primary Care Capitation payment.”
