Feb 10, 2021
CMS Direct Contracting is coming fast, is very nuanced, and full of grey. In a nutshell, 50% of Medicare patients are in Medicare Advantage (i.e., value-based care) and 50% are still Medicare fee-for-service (FFS). Direct Contracting is CMS’ bold play to quickly move many of the remaining Medicare fee-for-service (FFS) patients into value-based care.
If you’re a doctor who takes care of Medicare fee-for-service (FFS) patients, then it is going to affect you whether you’re paying attention or not. That’s doubly true if you’re in one of the 10 “Geo” model regions (Atlanta, Dallas, Houston, Los Angeles, Miami, Orlando, Philadelphia, Phoenix, San Diego, Tampa). In those regions, 100% of non-Medicare Advantage beneficiaries will have to align with one of three to seven awarded Direct Contracting Entities (DCE). DCE applications are due April 1, 2021 and all beneficiaries will be re-aligned under this fully capitated plan beginning January 1, 2022. Ya… that fast.
“There will no longer be any fee for service for all of Medicare and all of dual eligibles, which is Medicaid and Medicare eligible, in up to 10 regions of our country starting the first of next year.” Gail Zahtz, Founder and CEO, WiseCare
Today we’re talking with Gail Zahtz, Founder and Chief Executive Officer at WiseCare, a startup applying to become a Direct Contracting Entity (DCE). Gail helps us to understand the urgency of the situation and walks us through the nuance of the model. And while she acknowledges the hurdles for providers and the risks CMS’ rapid timeline imposes, she also embraces the opportunity that Direct Contracting represents. As a cancer survivor, Gail understands firsthand the difficulty of navigating our healthcare system and she believes Direct Contracting offers a pathway to really make a difference in how care is delivered. It makes new services and care models possible, and it allows doctors to care for patients in the way they dreamed of when they got into medicine.
Direct Contracting / Direct Contracting Entity (DCE) Topics Covered
There’s a lot here, and still a lot of open questions on Direct Contracting. We’re going to do our best to unravel this for you in the coming weeks. Drop me a note at don@thehcbiz.com and let me know what questions you’d like us to cover.
Gail Zahtz
Founder and Chief Executive Officer, WiseCare Inc.
Gail Zahtz has spent her career focusing on the intersection of
evidence-based healthcare and user-centric design to honor and
empower the doctor-patient relationship. An entrepreneur since the
1990s when she took a health-in-the-workplace property to $100M
valuation, she has served as an adviser to healthcare start-up
funders, a thought leader and advisor to industry on designing for
health outcomes, a consultant to health innovation startups, and
the architect of value-base healthcare delivery for NY’s largest
post-acute healthcare system. She has won numerous awards for
her work at the intersection of health and design, including: Top
100 in Health Info Technology, Top 100 International
Influencers in Health, and Top 50 Most Influential Health
Leaders. As a survivor of late-stage cancer and domestic
violence, Gail is dedicated to sharing her story of how to survive
and thrive in the most challenging of circumstance to show young
women everywhere a way forward.
Twitter: https://twitter.com/GailZahtz
LinkedIn: https://www.linkedin.com/in/gailzahtz/
About
WiseCare
WiseCare is an
Integrated Healthcare Collaboration Company, enabling doctors to
deliver true wrap-around care to Medicare patients by leveraging
the new value-based care models. WiseCare makes thriving within the
new capitated models seamless for physician practices and
alternate-level-of-care facilities. A partner, not just a payor, we
offer the ready-made collaborations and working partnerships across
the healthcare continuum that will be the key to success. And we’re
expert in helping physicians keep, grow, and better care for their
Medicare populations in this fast-changing environment. We lessen
administrative burdens, improve financial stability, provide the
data physicians need to make strategic care decisions, and deliver
benefit enhancements that pay off for patient and caregiver,
physician, and the practice. And our CareCoaches support patients
and care plans between office visits, providing: condition and
wellness education, targeted referrals to medical and social
providers, and resolution of issues that stand between your
patients and better outcomes.
That’s what we call Healthcare Made Well. To learn more about how
WiseCare can partner with you, email us at info@wisecare.health.
Web: https://www.wisecare.health/
LinkedIn: https://www.linkedin.com/company/wisecare-health/
Links and Resources
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