The New Geographic Direct Contracting Payment Model from CMS

CMS announced a new voluntary payment model: The Geographic Direct Contracting Model (Geo). Geo will test an approach to improving health outcomes and reducing the cost of care for Medicare beneficiaries in multiple regions. Through Geo, participants will take responsibility for beneficiaries’ health outcomes, giving participants a direct incentive to improve care across entire geographic regions. Within each region, organizations with experience in risk-sharing arrangements and population health will partner with health care providers and community organizations to better coordinate care.

The new model will test whether a geographic-based approach to value-based care can improve quality of care and reduce costs for Medicare beneficiaries across an entire geographic region.

Geo requires participants to take full risk with 100 percent shared savings / shared losses for Medicare Parts A and B services for aligned Medicare FFS beneficiaries in a defined target region. Geo will be tested over a six-year period in four to ten regions and will include two three-year performance periods, the first of which starts on January 1, 2022 and the second of which starts on January 1, 2025.

Beneficiaries included in the model must meet each of the following criteria:

  • Be enrolled in both Medicare Part A and Part B;
  • Not be enrolled in a Medicare Advantage plan, Medicare-Medicaid Plan (MMP), cost plan, PACE organization, or other Medicare managed care plan;
  • Have Medicare as a primary payer;
  • Be residents of the United States; and
  • Have their address of record in a region included in the Model.

Medicare beneficiaries included in Geo will maintain all of their Original Medicare benefits. Beneficiaries can continue to see any enrolled Medicare provider or supplier of their choosing.

Providers across many specialities may be able to take advantage of new flexibilities under Geo while also delivering better care to patients. These flexibilities/benefits include:

  • Streamlined access to a skilled nursing facility by waiving Medicare’s 3-Day SNF Rule;
  • Home visits for beneficiaries following a discharge from an inpatient hospital, psychiatric facility, inpatient rehabilitation facility, long-term care hospital, or skilled nursing facility;
  • Home visits for care management;
  • Increased access to home health care by waiving the homebound requirement for access to home health services in Medicare;
  • Asynchronous telehealth services for certain conditions; and
  • Access to curative care while receiving the hospice benefit.
  • Additional enhanced Medicare benefits may be detailed within the Request for Applications

The CMS Innovation Center expects to release a Request for Applications for the first performance period in January 2021.  This Request for Applications will include the aggregated historical data needed for potential participants to bid a discount in each region (see bidding details in the DCE section below).  The Innovation Center expects to solicit participants in four to ten regions for the first performance period. 

CMS expects applications to be due April 2, 2021.  CMS then expects to announce participants by June 30, 2021 and that DCEs will be required to submit their Geo Preferred Provider lists by September 1, 2021.  The first performance period will start on January 1, 2022.

Click here to read the press release from CMS.

Click here to read the fact sheet from CMS.