Providers Want Another Shot at Applying for Direct Contracting

Dozens of physician and hospital groups are seeking another opportunity to sign up for the new directing contracting model days after the CMS closed down applications for future cohorts.

The agency announced on the Global and Professional Direct Contracting Model page earlier this month that it would no longer accept applications as the Innovation Center (CMMI) undergoes a review of its portfolio of alternative payment models. The pause will impact the model’s second performance year, slated to launch on January 1, 2022.

Providers led by America’s Physicians Groups (APG), however, say this is the wrong move for the value-based care movement.

“We regard this unfortunate decision as a serious blow to the progress of the movement toward value-based care, perhaps the best hope for bringing higher quality and more affordable healthcare to all Americans,” the nearly 50 groups led by APG wrote in a letter to CMMI Director Liz Fowler.

The undersigned organizations including accountable care organizations (ACOs) California Clinical Partners ACO, Silver State ACO, and NW Momentum Health Partners ACO, as well as value-based physician organizations like Central Ohio Primary Care Physicians.

The providers asked CMMI to reopen the portal for applications to the directing contracting models and accept new applicants for the 2022 start date.

Newly minted CMMI Director Fowler said in her first public comments last week that the agency’s “commitment to value-based care has never been stronger” despite making several changes to its alternative payment models, including the Global and Professional Direct Contracting Model.

The agency has also paused the Geographic Direct Contracting Model, an offshoot of the Global and Professional Direct Contracting Model.

“Health system transformation is not easy, and it is an iterative process,” Fowler stated about the review of CMMI’s portfolio of alternative payment models. “Ultimately, at CMMI, we want our alternative care models to position participants for success and sometimes that means speeding up when there's an opportunity and sometimes it means taking a beat to ensure that a forthcoming model can realistically deliver on what's intended and that it's the strongest option based on our evidence and data.”

The Global and Professional Direct Contracting Model was notably introduced under the previous administration. The pathways offer a wider range of healthcare organizations the opportunity to participate in alternative payment models that offer capitated payments for care coordination along with quality improvement incentives.

But potential directing contracting participants are upset that the investments they made to participate in directing contracting pathways through CMMI will be wasted now that the second performance year has been delayed due to the closing of the application cycle.

“Potential participants have made substantial investments and conducted significant preparation in attempting to meet the requirements of participation for a January 2022 start date and to ensure that they are also able to embark upon the Model from the strongest vantage point possible because they regard it as America’s best hope in redesigning healthcare,” the provider organizations said in the letter.

The organizations believe the direct contracting options will improve quality of care in the US while bringing down costs—two major healthcare reform priorities for administrations for over a decade.

Fowler said CMMI is still dedicated to improving quality and reducing costs but the agency is refreshing its strategy for value-based care to emphasize healthcare transformation over strict measures of success, such as cost savings.

“Is cost savings the most important measure of success or does quality improvement count just as much? Is risk-bearing among providers the key to unlocking value? And at CMMI, is the ultimate goal expanding a model to become a permanent part of Medicare or is healthcare transformation the ultimate goal? It could be both, but in my time at CMMI, I want to take a look at these questions and think about the bigger picture issue and focus on longer term health system goals,” Fowler stated.

CMMI did not indicate when it will reopen directing contracting applications.