New payment model will advance regional value-based care

December 7, 2020
Keith A. Reynolds

CMS says the new model will see physicians taking responsibility for their patients’ health outcomes.

The Centers for Medicare & Medicaid Services (CMS) has announced a new payment model seeking to improve health outcomes and reducing the cost of care for Medicare beneficiaries.

According to a news release, the Geographic Direct Contracting Model will see participants taking responsibility for the patients’ health outcomes which will give them a direct incentive to improve care. In each region, organizations with experience with risk-sharing arrangements and population health will be partnering with physicians and community organizations to better coordinate care.

Patients in the model will maintain all of their original Medicare benefits such as being able to see any provider they choose. They can also receive enhanced benefits like additional telehealth services, access to home care, access to skilled nursing without an extended stay in the hospital, and concurrent hospice and curative care, the release says.

Participants will also be able to reduce patient cost sharing for Part A and Part B services, and also offer patients a Part B premium subsidy. These lower out-of-pocket costs would allow participants to push beneficiaries to seek high-value care while maintaining the freedom and choice present in the original Medicare program, according to the release.

“The need to strengthen the Medicare program by moving to a system that aligns financial incentives to pay for keeping people health has long been a priority,” CMS Administrator Seema Verma says in the release. “This model allows participating entities to build integrated relationships with healthcare providers and invest in population health in a region to better coordinate care, improve quality, and lower the cost of care for Medicare beneficiaries in a community.”

Participants will coordinate care and clinical management for beneficiaries in original Medicare in their region. This may include care management services, telemedicine, or educating patients on which providers have a history of delivering better results and lower costs over the long term. Patients will stay in original Medicare and maintain all of their benefits and coverage rights. They will also keep all of the protection of original Medicare; like access to all Medicare physicians and suppliers, freedom to choose and change physician at any time, and the appeals and ombudsman system, according to the release.