Some of the common questions we are hearing from our member base is around projecting historical benchmark calculations, understanding beneficiary counts, and voluntary alignment opportunities.
Key Decision Points
There are a number of key decision points that will need to be made prior to the implementation and/or performance period. Several of the key decisions are listed below. The CareJourney Direct Contracting Analysis will provide the key analytics needed to make an informed decision. Should you have any additional questions regarding each of the decision points below, please feel free to reach out to your CareJourney representative.
- Do I have a current or legacy TIN that I want to participate with? Or do I need to form a new one?
- Do I meet the minimum level for the number of beneficiaries for the program?
- Do I need to worry about another Shared Savings program?
- Who do I add to my Participant Provider to the Provider list?
- Should I add specialists to my Participant Provider to the Provider list?
- Who do I add to my Preferred Providers to the Provider list?
- Does my entity have any providers that are billing under multiple organization billing NPIs, that could potentially be under another TIN, that I have to be worried about?
Common Approaches to the Implementation Period
The implementation period is intended to help New Entrants DCEs build an aligned FFS population by testing enhanced opportunities for voluntary alignment. This period provides DCEs with additional time to engage in alignment activities and plan their care coordination with management strategies prior to the first performance year.6
After speaking to our member base, we are seeing a few different approaches to the implementation period which is found below.
Option A: Select an Existing TIN and test Voluntary Alignment Activities
Option B: Select an Existing TIN and test DCE Leakage Shifts
Option C: Select a Handful of Providers (new TIN) and test Voluntary Alignment Activities
Option D: Select a Handful of Providers (new TIN) and test DCE Leakage Shifts
After speaking to the organizations that use an existing TIN, they plan on entering the performance period with the entire TIN or are planning to form a new TIN depending on their progress under the implementation period. For their providers with high leakage and a high total cost of care, they’re particularly focused on improving both of those metrics to be included in the new TIN. Unfortunately, there is no one-size-fits-all approach but each of the above options have their pros and cons and it is up to the DCE to determine what approach works best for them.
- Voluntary Enrollment efforts
- Total Cost of Care
- Types of DC
- Participant/Preferred Providers
For organizations looking for more guidance on Direct Contracting, NAACOS has launched a direct contracting taskforce7 and America’s Physician Group’s Risk Evolution Task Force is also focused on helping organizations take on Direct Contracting.
Outstanding Questions for CMS
After reviewing the content released by CMS, there are still several outstanding questions that the public is waiting for.
- What is the proposed Risk Adjustment Methodology that the DC Model will use? Although comments have been made about the methodology not being impacted by coding, we have seen no additional details on it.
- When should we expect to see more about the Geographic PBP Option? With both the Global and Professional options coming with a number of questions around methodology and eligibility requirements, we can expect to see the same from this option.
- In order to calculate shared savings/losses, the adjusted MA Rate book will be needed to calculate voluntary alignment impact. When can we expect that to be released?
Explore with CareJourney
Want to understand the historical performance of your Provider Participants to better project how they will perform under DC?
CareJourney has the tools necessary to help you make the best decision for both the implementation and performance periods. From providing historical performance details, to projecting your claims assigned beneficiaries, to measuring performance during the implementation/performance periods, to helping you set up Data at the Point of Care or Blue Button.
Please contact us using the link below for more information or to request a meeting.