MAOs Dabble in FFS Medicare Via Direct Contracting Model

As CMS kicks off the first performance year of a new care delivery model — in which provider groups and other entities will share risk and receive capitated payments for serving fee-for-service Medicare beneficiaries — the initial round of participants indicates solid interest from Medicare Advantage organizations. Meanwhile, CMS has paused applications for future years of the so-called direct contracting model and is reevaluating a component that would have included Medicaid managed care organizations, raising questions as to what other value-based care models the CMS Innovation Center might have in the works or what modifications it could potentially make to this one.

After an implementation period last fall in which participants weren’t accountable for costs or quality, the first performance year of the Global and Professional Direct Contracting (GPDC) Model began on April 1 and involves 53 Direct Contracting Entities (DCEs) that will serve FFS beneficiaries in 38 states as well as the District of Columbia and Puerto Rico, the Innovation Center announced on April 8.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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