Supplier groups initiate drive to maintain direct contracting model

Federal regulators are pondering the future of the direct contracting program and an announcement could be made soon that will worry some supplier groups.

Interest groups are calling on the Centers for Medicare and Medicaid Services to change, but not discard, the Global and Professional Direct Contracting portion of the program.

The push came after progressive lawmakers called on the administration to stop the program, saying it was turning traditional Medicare into a Medicare Advantage and that profit-driven participants could hurt patient care. But some advocates of direct contracts fear a domino effect of political influence on the Center for Medicare and Medicaid Innovation demonstrations.

A CMS spokesperson said the agency is actively listening to feedback on the GPDC and those comments are “invaluable” as it considers the model’s future. CMS will provide more information on the fate of the model soon, the spokesperson added.

Health care provider associations, including the American Physician Groups, the National Association of Responsible Health Organizations, and the Premier Group Purchasing Organization, are reaching out to each other and their members to lobby CMS to keep the GPDC program intact. The groups plan to send a letter to Department of Health and Human Services secretary Xavier Becerra on Monday evening and said they heard the announcement could be made as early as Tuesday.

“Direct contract is an essential, high-risk, value-based payment model designed to improve patient care. Please save the model and make any necessary adjustments, otherwise we risk taking a step back in our efforts to provide better patient care at a more affordable price. lower cost, etc. letter is reading.

The Direct Contract Program is part of CMS’s commitment to providing value-based care. The initiative has recently taken on new meaning as the agency unveiled its goal in October to have all Medicare recipients benefit from value-based services by 2030.

GPDC builds on previous ACO CMMI models, offering higher levels of risk and greater reward opportunities. In 2021, 53 organizations participated, with another intake starting on January 1st, although CMMI has yet to announce 2022 participants and has put applications on hold.

A separate model, Geographic Direct Contracting, would allow organizations to bid on the total cost of risk for Medicare pay-for-service recipients in a given region. Last spring, CMMI suspended work on the geographic model before it went live.

Supplier groups letter calls on CMMI to formally abolish geographic direct contracting model as it is being confused with global and professional options. But the GPDC incentivizes better care for people with higher needs, and ending the program would harm health equity efforts, the letter said.

The letter calls for the agency to fix rather than terminate the GPDC. APG executive vice president of federal affairs Walinda Rutledge said CMMI could increase the minimum percentage of doctors on the direct contracting organization’s governing body to make it more provider-focused and allay concerns about the influence of insurers or private investors. Electricity guidelines require that only 25% of the governing body be made up of participating vendors.

CMMI may also want to create a more level playing field in the GPDC for organizations that have previously participated in ACO models, said David Olt, direct contract stakeholder consultant and former head of financial risk at CMMI. The current system gives new participants in CMMI risk models, including insurers, an advantage because previous attempts to become more efficient are not reflected in their benchmarks.

“This is a model, this is not a permanent program. So this should be a test,” Ault said, adding that CMMI could make a few other changes. “That’s why you’re doing these things to find out what can and should be fixed and improved.”

But stakeholders fear that the standard process for fixing CMMI models as they become available could collapse under political pressure. Direct contracting in general has recently been criticized by progressive lawmakers who argue that the program essentially privatizes traditional health care. Dozens of representatives signed letter Led by Rep. Pramila Jayapal (D-WA), last month called on HHS to permanently end both direct geographic contracts and GPDCs.

Senator Elizabeth Warren (D-Massachusetts) also slandered opposed direct contracts during a Senate finance subcommittee hearing earlier this month, arguing that the program enriches private investors and organizations. Some service providers, mostly led by Physicians in the National Health Program, are also advocating the end of the program.

Opponents of Direct Contracting point out that private equity-backed entities and MA insurance companies control some program participants and may abuse risk regulation to make more money. But the GPDC imposes limits on diagnostic coding, although Ault notes that there are exceptions to those limits for many beneficiaries that fit the model’s new entrants. Beneficiaries also retain their right to contact any traditional Medicare provider, even if they are associated with a direct provider, and may choose not to share data with CMS.

GPDC is the largest population health model currently operating through CMMI. Many vendor groups that participated in earlier ACO programs moved to GPDC after the next-generation ACO model ended late last year, according to NAACOS.

“Direct contracts and other advanced alternative payment models have enabled VillageMD to innovate and improve patient care,” said Gary Jacobs, executive director of VillageMD’s Center for Government Relations and Public Policy. VillageMD manages six direct contractors.

Under the GPDC, he said, providers can purchase refrigerators so their patients can store insulin and perform other medical interventions that are nearly impossible with traditional Medicare.

“Direct contracts drive the general expansion of quality and primary care, and do so by building up cost recovery confidence year after year, which is a big, big problem. And that’s probably one of the reasons we might be planning an aggressive expansion of services to health deserts or underserved urban and rural communities,” he added.

The fate of the program may have larger implications for CMS and value-based care. Getting rid of the average model performance period can cause vendors to lose confidence in future CMMI models.

“You have to be sure that what you’re implementing is going forward as advertised because we’ve set it up and patients deserve service, doctors they expect service,” said Melanie Matthews, CEO of PSW, who worked on it. ACO via ACO Next Gen. Matthews said the natural progression for her ACO would be to move to GPDC.

“For me, this is a threat in general to all value-based care models. Not only for direct contracts, but, you know, for their idea,” she said.

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