Give Medicare time to directly negotiate a contract to prove its value or expose its weaknesses.

Health experts have argued for years that we should move away from dysfunctional, unstableMedicare fee-for-service reimbursement and value-based models that incentivize better health outcomes, such as reduced hospitalizations and post-accident care costs.

Unfortunately, one of the federal center’s most promising value-based Medicare and Medicaid innovation programs is facing a coordinated attack from Medicare for All advocates who want to end it before there is concrete evidence of what it brings. benefits patients, providers, and the Medicare system. .

Campaign to End the Direct Contract Program led Physicians for a National Health Program, an organization advocating for a universal national health program with a single payer. Their main argument against the direct contract program is a time-tested and deeply partisan one—that it is a covert attempt to “privatize Medicare” because some direct contracting organizations (DCEs) are owned by commercial companies. Is not.

We must know. VillageMD is one of the leading DCEs in the modeling program. Our physicians appreciate that this puts primary care providers at the center of medical teams and rewards physicians who build ongoing relationships with patients. By providing payments to each person in a provider’s care based on the burden of disease, the program encourages the overall health of patients rather than delivering health care services piecemeal. Patients retain the freedom to choose any Medicare provider.

By not focusing on volume, primary health care providers can spend the time needed to provide high quality care, especially for chronically ill patients who require comprehensive treatment plans. In the United States, more than $4 trillion is spent annually on healthcare, and more than 85% of this amount is spent on patients with chronic diseases. Keeping these people healthy for longer is a potential source of huge savings for the healthcare system and can enable people to live more fulfilling lives. Coordination of care across multiple settings promotes a long-term partnership with the patient, which is a prerequisite for improved management of chronic conditions.

Primary health care practitioners are getting more investment through a direct contracting model that encourages service providers to build clinics and create access in underserved rural and urban communities. VillageMD is committed to launching primary health care practices in more than 500 underserved areas that will serve millions of Medicaid and Medicare Americans in the care deserts.

The direct contracting model builds on private sector approaches to risk-sharing and payment mechanisms and reduces the administrative burden. Risk adjustment means that the provider is paid more if the patient is sicker because it will take more time, effort, and expense to treat the patient. One of the benefits of risk adjustment is that it focuses on the patient’s diagnosis rather than creating meaningless pay tasks and measurements that add no value to the patient.

Critics of the direct contract suggest that DCEs will conduct aggressive diagnostic “upcoding” and misclassify patients in order to qualify for higher risk-adjusted payments. In fact, DCEs are subject to many encoding restrictions and risk management of direct contracts is not undermined by complex rules and litigation which restrict the government’s actions in case of incorrect coding in Medicare Advantage. The ability to improve risk adjustment oversight and train suppliers in effective coding practices is a reason to keep the direct contracting program in place rather than prematurely ending it.

DCEs are not eligible for general savings without reaching CMS quality standards. Compared to previous existing initiatives, direct contract payment models include a more stringent set of quality indicators that are more focused on the results and experience of the beneficiary than on the process.

There will be starts and stops along the way to a Medicare system that better serves patients, but ultimately value-based care is key to improving health outcomes and lowering costs to the system. In 2021 KIMI the introduction of another model has been suspended a direct contract in which DCEs were required to bid for the ability to take on financial risk for the entire population of paying Medicare beneficiaries in certain geographic areas. Given the significant capital and administrative resources required for DCE in a geographic model, many would not be able to participate and fear they would be marginalized from a value-based care system. The current direct contract program does not raise these concerns and gives beneficiaries the freedom to choose among Medicare providers.

In the long term, the key to the success of value-based models such as direct contracts is the provision of quality care that is personalized, preventive, comprehensive and equitable. This is the first year of a planned six-year model program. During this time, CMS will determine if it is providing valuable patient care and savings to Medicare or not. This assessment should be based on data, not policy.

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