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Providers, payers see direct contracting's capitation as an important move to value-based care

Photo: Cecilie Arcurs/Getty Images
Over the past several years, the big trend in healthcare has been to inch away from fee-for-servicereimbursement and toward value-based care, in which a provider s reimbursement is tied more to clinical quality than to volume. The industry, policymakers and the federal government have attempted this shift through a number of legal and regulatory means, and one policy that has proven popular in this regard, among both providers and payers, is direct contracting.
In basic terms, direct contracting is a population-based model that allows for the use of capitation. This is what sets it apart: Aside from Next Gen and Pioneer, virtually all of the other compensation-based models from the Centers for Medicare and Medicaid Services are billed as fee-for-service, with a reconciliation 18 months later. ....

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Direct contracting model pause leaves healthcare in limbo

Modern Healthcare Illustration / Getty Images
A former senior Trump administration official lambasted the decision, calling it a big blow to value-based care. While some healthcare organizations forged ahead with the GPDC model despite the pandemic, others held off until they weathered the storm. CMMI had told interested organizations that they could join the model after the pandemic ended, so many of them decided to wait to apply.
Now many would-be participants are in limbo, as the agency decides the fate of the model or its possible replacement. The uncertainty has created widespread consternation among existing accountable care organizations and all new direct contracting entities backed by managed-care organizations or venture capital firms. Many of them would have applied for the pilot project last year if they knew CMMI would pause new applications for 2022, experts said. ....

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Detailed Agenda for the 2021 State of Reform Federal Conference now available! - State of Reform

Detailed Agenda for the 2021 State of Reform Federal Conference now available!
Kaylor Erickson | Mar 11, 2021
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We have carefully crafted these panel topics after a long process of stakeholder engagement that helped us zero in on the health care policy topics most important and relevant to Washington.

Sen. Ron Wyden:
Kathleen Nolan:
Frank McStay:
Ron Bialek:
Christopher Murray, MD:
Congresswoman Allyson Y. Schwartz:
Valinda Rutledge:
Rep. Earl Blumenauer:
Member, House Ways & Means Subcommittee on Health
These are just a sampling of the speakers confirmed to be a part of the program on April 7th and 8th.
If you’re not yet registered to join us, register today to reserve your spot and hear from this great list of speakers. You can also drop us a note if you have any questions about the conference. We look forward to seeing you there! ....

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Medicare Payment Reform's Next Decade: A Strategic Plan For The Centers For Medicare And Medicaid Innovation

Medicare Payment Reform's Next Decade: A Strategic Plan For The Centers For Medicare And Medicaid Innovation
healthaffairs.org - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from healthaffairs.org Daily Mail and Mail on Sunday newspapers.

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