Most are in the riskier global risk track with 100% savings and losses.
The Center for Medicare and Medicaid Innovation (CMMI) announced the selection of 53 Direct Contracting Entities (DCEs) today for participation in its two-track direct contracting model that started on a new performance year in April 1.
Thirty-nine of the selected DCEs have picked the “global risk sharing” option and 14, the less risky “professional” track. Organizations in the global track can collect 100% of the difference between the organization’s spending and certain financial benchmarks (“savings”). They are also at risk, though, for 100% of “losses” — spending over the benchmark.
Those in the professional track are taking on less financial risk and are eligible for 50% of the savings or losses.
François de Brantes, a senior vice president at Signify Health and a member of the Managed Healthcare Executive® editorial advisory board, expressed disappointment that CMMI has decided not to accept more applicants into future years of this direct contracting model, the formal name of which is the Global and Professional Direct Contracting Model. CMMI has another direct contracting model called the Geographic Direct Contracting Model, which is currently under review.
“CMMI was going to open up a new enrollment window for those who wanted to get in for next calendar year (2022) and beyond, and this notice indicates they are not opening up the window and accepting additional participants,” de Brantes said in an email. “It’s somewhat surprising and disappointing because there are a number of organizations that wanted to participate in this program and were waiting for the new enrollment window to open.”
Today’s notice from CMMI says that organizations that have applied and chosen to defer their participation in the model till next year can do so but that it won’t be accepting new applications: “At this time the Innovation Center will not be accepting new applications from any new organizations, including organizations interested in participating in the model as a Medicaid Managed Care Organization-based (MCO-based) DCE.”
Clif Gaus, Sc.D., president of the of the National Association of ACOs, commended the direct dontracting participants for “advancing Medicare payment and delivery reform” in a press release. But Gaus also expressed concerned about the future of ACOs, especially the Next Generation ACOs. “Next Generation ACOs need clarification on what happens to their participation in high-risk, accountable care models. Next Gen offers a better option and bridge to capitation than the Shared Savings Program,” said the press release.
Forty-one organizations are participating in the Next Generation ACO program, which involves greater risk and the risk of losses but also loosens some Medicare regulations for the organizations.
In addition to sorting the 53 DCEs into global and professional tracts, CMMI has grouped them into “standard” and “new entrant” DCEs. The 31 standard DCE are organizations with experience with fee-for-service Medicare beneficiaries and often with a track record in an ACO program. The 16 new entrants are organizations thathaven’t traditionally provided services to Medicare fee-for-service beneficiaries. A third of six serve high-needs populations.