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The new model introduced by CMS was designed to promote value-based care and drive innovative strategies to improve outcomes for high-risk populations

In December 2020, the Centers for Medicare and Medicaid Services (CMS) introduced an option for certain Medicaid managed care organizations (MCOs) to become Direct Contracting Entities that will coordinate care and share risk for dual-eligible individuals who access Medicare benefits through fee-for-service.

“Any approach that can possibly improve outcomes is worth exploring, and we appreciate the willingness of CMS to try different models like this,” echoes Chris Palmieri, president and CEO of Boston-based Commonwealth Care Alliance (CCA), one of the largest and top-rated MMPs in the U.S. Although the DCE model has the potential to improve duals’ care, “it’s far too early to tell as the requirements around integration of benefits, quality standards, etc. have yet to be defined,” he says.

“CCA has been fortunate to effectively operate in this environment for some time, but a national view reveals mixed outcomes for organizations operating integrated MMPs/FIDE-SNPs. The potential for success of CMS’s expanded Direct Contracting Model will be predicated on keeping the bar high regarding an organization’s capacity to navigate across both benefits and show a track record of improving quality, all while being a strong fiscal steward for state Medicaid agencies and CMS.”

CCA Media Contact