New payment arrangements will hold groups of providers accountable for total cost and quality.

Last year, the Centers for Medicare and Medicaid Innovation (CMMI) announced the Direct Contracting Model, where an entity, working with a group of preferred providers, can take full risk on a population of Medicare beneficiaries. CMMI offered several participation options under this model, and has recently announced the 51 lead organizations (called “direct contracting entities”), many of whom are CAPC members and Learning Community participants working to improve the care of those living with serious illness. Now, CMMI has added new opportunities for direct contracting, including a “Geographic Model,” where entities can take responsibility for all Medicare beneficiaries (not enrolled in Medicare Advantage) who reside in a specific geographic area, and an opportunity for Medicaid managed care organizations to take responsibility for and coordinate both Medicare and Medicaid benefits. These Direct Contracting models present significant opportunities to ensure access to palliative care for Medicare beneficiaries in need, and in fact, these models come with important waivers, including the ability to provide hospice concurrent with treatment. The applications for the Geographic Model, the Medicaid MCO model, and others are expected to be released in January.

For more information on the Direct Contracting Model and its implications for palliative care, see our earlier blog, “Medicare Direct Contracting Model and the High Needs Population.”