The Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation recently announced a new opportunity for managed care organizations (MCOs) that serve beneficiaries dually eligible for Medicaid and Medicare. The new model builds on previously announced direct contracting opportunities that test financial risk-sharing arrangements to reduce Medicare expenditures while preserving or enhancing quality of care for beneficiaries.
Through this new initiative, MCOs can participate in direct contracting for their dual-eligible populations. Further, MCOs will have additional incentives to provide comprehensive care to dual-eligible beneficiaries, including:
- risk-stratifying and targeting care coordination resources toward aligned beneficiaries at risk of high Medicare spending;
- training and deploying care coordinators and in-home aides to help with Medicaid long term services and supports in addition to managing Medicare-covered medical appointments to limit missed treatments; and
- entering value-based purchasing arrangements with nursing facilities that factor in facilities’ hospitalization rates.
MCOs or legal entities affiliated with MCOs are eligible to participate in the new model and can engage in both professional and global risk sharing options, which are explained in depth in a CMS fact sheet. For more information on direct contracting, visit CMS’ direct contracting model options webpage.
Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.