Late on Wednesday, CMS released the 2021 Performance Year data on the Direct Contracting Program. Remember that/? It was all the rage way back in 2021. Notwithstanding the reputational damage incurred by the hapless CLOV, the GPDC program has a lot of potential. It is one of the few efforts by CMS to make the practice of medicine in hard to serve communities viable. Progressives in Congress, ironically, worked to end the program but Liz Fowler at CMMI persevered. Having evaded the political traps, the program is here to stay and appears to be viable even though it is very tiny.
Direct Contracting Entities are paid a capitated amount under either the Professional or Global model. Under the Professional Model, DCEs are focused on physicians' care where as under the Global Model they are responsible for all care along the continuum. The risk arrangement under the Professional Model is 50-50, under the Global Model it is 100%.
The number of participants are small for each DCE - in the low thousands - with the exception of CLOV which has - or had, they announced they are backing away from the project - about 64k participants.
We hear a lot of negative comments about OSH but they appear to be doing well with the program. Could they be withholding care? Hard to know. They work with difficult populations who get batted around a system and tend to be overtreated. We will await some quality data.
WBA's VillageHealth affiliation performed well with Caremore, an ELV unit doing more poorly than CLOV.
Still early, still small but the program holds promise for both the DCEs and the government.
Let me know what you think.
Emily Evans
Managing Director – Health Policy
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