decisionhealth Newsletters, Part B News - 2022 Issue 2 (February)
Turmoil over Direct Contracting model has CMS mulling changes
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Article Overview
This article covers the debate over CMS’s Direct Contracting model, including criticism from policymakers and health care experts, stakeholder pushback, and discussion of possible program changes. It is relevant for Medicare policy stakeholders, value-based care organizations, coding and reimbursement professionals, and providers following CMS innovation models. The piece focuses on the model’s structure, governance, risk adjustment concerns, and broader implications for accountable care and Medicare payment policy.
Why This Topic Matters
The article helps readers understand a CMS payment-model issue that could affect participation, governance, and program design in value-based care. It also places the discussion in the context of broader Medicare policy, risk adjustment scrutiny, and accountable care trends.
Article Sections
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Update
A brief update on CMS action related to the model and its planned rebranding, along with noted changes under consideration.
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Concerns of ‘risk-score gaming’
Background on criticism of the model, comparisons with related Medicare payment models, and stakeholder concerns about governance, ownership, and risk adjustment.
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A reform consensus
Discussion of political, industry, and expert reactions to the controversy, including proposed refinements and broader implications for value-based care.
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Resources
Source citations and related reading referenced by the article.
What You Will Learn
- How CMS’s Direct Contracting model became controversial
- What types of stakeholder concerns were raised about the model
- How the article situates Direct Contracting within broader Medicare payment policy
- Why risk adjustment and governance issues are part of the debate
- What kinds of changes were being discussed for the program
Who Should Read This
- Medicare policy professionals
- Value-based care organizations
- Health care administrators
- Medical coding and reimbursement professionals
- Provider groups participating in CMS models
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