WASHINGTON, D.C., April 24, 2018

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a Request for Information (RFI) on a new initiative in which the agency would contract directly with providers through a new payment model. This direct provider contracting (DPC) model would be similar to ACO models in terms of an accountability for certain costs and quality of a specific patient population and emphasizing primary care, but it also differs in many ways. “We’re pleased to see CMS considering more options for provider accountable care models and look forward to working with the agency to help shape this into a meaningful program that complements the existing Medicare ACO options,” said Clif Gaus, President and CEO of NAACOS. 

The RFI explains a number of notable differences between existing ACO options and the DPC model. For example, beneficiaries would have to select a primary care practice and actively enroll with participating organizations, and there would be per beneficiary per month payments. CMS is soliciting feedback on a number of key program elements, such as potential levels of risk, if organizations would participate independently or through a convening organization like an ACO, and what support CMS would need to provide to participants. Gaus further comments, “NAACOS has been advocating for increased beneficiary engagement tools, flexibility from onerous regulations and administrative burdens, and new opportunities for payment mechanisms other than fee-for-service, so there are a number of valuable concepts incorporated into the outline of the DPC model. It will be imperative that CMS calibrate model details like risk and accountability appropriately in order for this to be a success.” 

The RFI solicits feedback on how direct provider contracting would interact with, enhance and/or refine current ACO initiatives. Gaus responds, “Given the progress we have seen with ACO development and care transformation, it’s essential that a direct provider contracting model work alongside ACOs. As Medicare payment models evolve through the introduction of new models, it’s essential that we also fix and improve existing models like ACOs. We’re focused on building off of the lessons learned by reinforcing ACOs through positive program changes and will continue to advocate to CMS to do just that as well as consider new accountable care opportunities.” 

Allison Brennan
Vice President of Policy