Direct Contracting: It’s Coming Fast and Will Have a Big Impact on Medicare-fee-for-service w/ Gail Zahtz

CMS Direct Contracting is coming fast, is very nuanced, and full of grey. In a nutshell, 50% of Medicare patients are in Medicare Advantage (i.e., value-based care) and 50% are still Medicare fee-for-service (FFS). Direct Contracting is CMS’ bold play to quickly move many of the remaining Medicare fee-for-service (FFS) patients into value based care.

If you’re a doctor who takes care of Medicare fee-for-service (FFS) patients, then it is going to affect you whether you’re paying attention or not. That’s doubly true if you’re in one of the 10 “Geo” model regions (Atlanta, Dallas, Houston, Los Angeles, Miami, Orlando, Philadelphia, Phoenix, San Diego, Tampa). In those regions, 100% of non-Medicare Advantage beneficiaries will have to align with one of three to seven awarded Direct Contracting Entities (DCE). DCE applications are due April 1, 2021 and all beneficiaries will be re-aligned under this fully capitated plan beginning January 1, 2022. Ya… that fast.

“There will no longer be any fee for service for all of Medicare and all of dual eligibles, which is Medicaid and Medicare eligible, in up to 10 regions of our country starting the first of next year.” Gail Zahtz, Founder and CEO, WiseCare