News Briefs: CMS Unveils Change to Direct Contracting Model

CMS on Feb. 24 released plans to revamp the Global and Professional Direct Contracting model, which allows participants to share risk and receive capitated payments for serving fee-for-service Medicare beneficiaries. Democrats like Washington Rep. Pramila Jayapal and Massachusetts Sen. Elizabeth Warren have criticized the model for transforming “the care of a traditional Medicare beneficiary to care typically seen in a private Medicare Advantage (MA) plan despite the fact that the patient chose not to enroll in an MA plan,” in Jayapal’s words. However, in good news for insurers like Clover Health, which are counting heavily on direct contracting revenue, CMS appears to still allow health insurers to apply for the renamed ACO Realizing Equity, Access, and Community Health (REACH) Model. As part of the overhaul, CMS promised greater “participant vetting, monitoring and transparency,” more promotion of provider leadership and governance, and a larger focus on health equity, among other changes.

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AIS Health Staff

AIS Health Staff

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