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Photo: John Fedele/Getty Images

Cigna subsidiary CareAllies, which helps providers simplify and accelerate value-based care, will participate in the Center for Medicare and Medicaid Services’ Global and Professional Direct Contracting (GPDC) Model in an effort to contract with healthcare providers to offer coordinated, value-based care to Medicare beneficiaries.

This, said Cigna, would expand CareAllies’ national footprint of more than 60 provider groups managing care for nearly 500,000 patients, and would make it easier for providers to meet the needs of Medicare beneficiaries.

The move comes despite the fact that CMS recently redesigned its Medicare Direct Contracting Model to an Accountable Care Organization model focused on health equity. The ACO Realizing Equity, Access, and Community Health (REACH) Model will replace the GPDC Model at the end of the year.

CMS said it would operate the GPDC Model until the end of December, with more robust and real-time monitoring of quality and costs for model participants. Those entities restricting medically necessary care will face corrective action and potential termination from the model, CMS said.

Despite that development, Cigna said the GPDC Model will enable CareAllies to improve health outcomes through CMS’ Shared Savings Program. That model is designed to improve quality of care while further reducing expenditures for Medicare beneficiaries, especially those with complex, chronic conditions.

WHAT’S THE IMPACT

Contracting directly through CareAllies, participating providers will serve Medicare beneficiaries across Texas and Arizona. Through the model, Cigna expects providers will be able to  collaborate with CareAllies, as well as community organizations, to better coordinate care, decrease burden and improve health across those regions.

CareAllies was ranked the number one value-based care solution for physician organizations from 2018-2022 by Black Book Market Research. Optimizing patient care centers around the company’s provider engagement capabilities, clinical model, governance support, and analytics and reporting that leverage population health data.

Fifty-three entities participated in the GPDC model’s first performance period, which began April 1, 2021.

THE LARGER TREND

It’s unclear what the impending end of the GPDC model means for CareAllies’ participation in the program. It’s also uncertain what reaction the ACO REACH model will garner once implemented.

The GPDC model was controversial because opponents, including progressive Democrats, believed it would lead to the privatization of Medicare.

Physicians for a National Health Program, an organization of 25,000 doctors who support Medicare for All and oppose Medicare privatization, have rejected the ACO REACH model, as it did the GPDC.

“ACO REACH is Direct Contracting in disguise,” said Dr. Susan Rogers, an internal medicine physician and president of PNHP. “This new model doubles down on Direct Contracting’s fatal flaws, inserting a profit-seeking middleman between beneficiaries and their providers. ACO REACH will pay middlemen a flat fee to ‘manage’ seniors’ health, allowing them to keep 40% of what they don’t spend on care as profit and overhead.”

PNHP objections include the potential for middlemen to restrict patient care and the fact that traditional Medicare beneficiaries will still be automatically enrolled into ACO REACH entities, as they were with direct contracting, without their consent. Once enrolled they cannot cannot opt out unless they change primary care providers, PNHP said. 

Also, companies that can participate include private equity investors and other profit-seeking firms that are ultimately accountable to investors, the organization said. 

Others applauded CMS’s redesign.

The National Association of ACOs president and CEO Clif Gaus said, “Many of the criticisms against Direct Contracting were a product of great misunderstanding about the model and the overall shift to value-based payment. Instead, keeping the model with additional focus on equity, increased provider governance, improvements to risk adjustment, and other changes is best moving forward.”

Premier said, “The redesigned model improves upon the earlier iteration of Medicare Direct Contracting by ensuring that healthcare providers are in the driver’s seat. ACO REACH includes several updates for which Premier has long advocated including reducing discounts to ensure providers have adequate payment under the Global track, reducing the quality withhold and applying consistent methodologies and policies across participants to ensure healthcare providers have the same opportunity to participate as non-providers.”
 

Twitter: @JELagasse
Email the writer: [email protected]



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