The introduction of CMMI’s new Direct Contracting model represents a unique opportunity for stakeholders across the care continuum – including health systems, physicians, health plans, SNFs and Medicaid MCOs – to participate in value-based programs with increased flexibility and benefits, but without the same barriers as other value-based payment programs. In Direct Contracting, successful organizations have the potential to not only save money, but also earn money through high performance under the program’s quality measures.
Direct Contracting quality measures
In the program’s first year, which began April 1, 2021, there are only two quality measures under which Direct Contracting Entities (DCEs) will be evaluated, both of which are based off of claims data. The first, Risk-Standardized All-Condition Readmission (ACR), examines the number of hospital stays that resulted in a readmission within 30 days of discharge. The second measure is All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (UAMCC) and looks at the number of hospital admissions that occurred among Medicare FFS beneficiaries who are 65 and over and have multiple chronic conditions.
Direct Contracting is a high-risk, high-reward program. To succeed in Direct Contracting, real-time data and a scalable technology solution are critical to course correct before an adverse event – such as a readmission – occurs and appears in claims-based reporting.
Leveraging CarePort to achieve Direct Contracting success
CarePort provides the tools and real-time data for providers who are managing risk and looking to reduce readmissions and utilization. DCEs that select CarePort can achieve the following:
- Proactively influence care during discharge planning workflows: CarePort Guide surfaces information during the discharge planning process and helps DCEs guide patients in post-acute care selection, achieving a better course of care for the member and reducing the likelihood of an adverse event at the post-acute level of care. CarePort is already embedded in discharge planning workflows in 1,000 hospitals and more than 110,000 post-acute providers nationwide.
- Engage members when they’re most vulnerable and ready for care: Through CarePort Connect’s real-time alerts, DCEs can engage a member when he or she is most vulnerable and ready to enroll in a care program or eligible for supplemental benefits that are part of the Next Gen ACO model – such as the three-day SNF waiver. This allows for course correcting before an adverse event occurs, and enables DCEs to do so at scale. Relying solely on outdated claims data, DCEs will miss out on timely opportunities to engage with their beneficiaries.
- Operationalize care management programs with acute and post-acute data: As physician groups consider entering the Direct Contracting model – and as a result increase their risk – they need data from both the acute and post-acute levels of care. Leveraging an established network of acute providers, post-acute providers and physicians that already work together to coordinate care, CarePort connects DCEs with cross-continuum data.
Ultimately, CarePort can help operationalize care coordination aspects of the Direct Contracting Model to reduce readmissions and unnecessary admissions, lower post-acute spend and utilization, and improve care management processes and member engagement.
This is the second post in our Direct Contracting blog series. In case you missed it, we introduced Direct Contracting in this post. Contact us to learn how CarePort can help your organization succeed under the Direct Contracting program.