What is Direct Contracting?

Direct Contracting is a new model from CMS that enables the creation of Direct Contracting Entities (DCEs).

DCEs enable participants to transition their Traditional Medicare populations to value-based care via a capitated reimbursement model, creating a predictable flow of revenue, and the opportunity to generate shared savings, creating incentives for providing more efficient care.

Pearl Health identifies opportunities for providers to participate in Direct Contracting and gives them the tools to succeed.

How is Direct Contracting Different from
other Value Based Care (VBC) programs?

The Direct Contracting model improves on past Medicare value-based programs by offering added flexibility and support for PCPs:

Enhanced revenue opportunities for PCPs, including stable monthly payments and shared savings

Reduced patient cost sharing and out-of-pocket expense for patients

Easier access to post-acute providers including skilled nursing and home health providers

Why You Are Probably
Frustrated with Value
Based Care (VBC):

How Direct
Contracting is
Different:

“The VBC attribution list excludes many patients for whom I am caring.”

Direct Contracting allows patients to be added to the attribution list when they complete a form designating a PCP.

“Many patients do not follow my care plan and miss follow-up visits due to costs.”

Direct Contracting 1) reduces cost sharing for visits to your office and 2) provides patient incentives for following your care plan.

“My patients ignore my referrals. The ‘leak’ to low quality providers, reducing my shared savings.”

DCEs can build a preferred network of specialists, encouraging patients to visit higher quality providers.

I need cash flow today to pay for my care management activities. Other VBC programs make bonus payments almost a year later.”

DCEs pay providers a fixed per-member-per-month, giving revenue stability needed to invest in patient care.

“Most VBC programs have burdensome and costly quality reporting requirements.”

The Direct Contracting model’s quality measures are based on claims and patient satisfaction surveys, not complicated data submissions.

Why You Are Probably
Frustrated with Value
Based Care (VBC):

“The VBC attribution list excludes many patients whom I am caring for.”

“Many patients do not follow my care plan and miss follow-up visits due to costs.”

“My patients ignore my referrals. They ‘leak’ to low quality providers, reducing my shared savings.”

I need cash flow today to pay for my care management activities. Other VBC programs make bonus payments almost a year later.”

“Most VBC programs have burdensome and costly quality reporting requirements.”

“The VBC attribution list excludes many patients whom I am caring for.”

“The VBC attribution list excludes many patients for whom I am caring.”

How Direct
Contracting is
Different:

Direct Contracting allows patients to be added to the attribution list when they complete a form designating a PCP.

Direct Contracting 1) reduces cost sharing for visits to your office and 2) provides patient incentives for following your care plan.

DCEs can build a preferred network of specialists, encouraging patients to visit higher quality providers.

DCEs pay providers a fixed per-member-per-month, giving revenue stability needed to invest in patient care.

The Direct Contracting model’s quality measures are based on claims and patient satisfaction surveys, not complicated data submissions.

See what Direct Contracting could mean for your practice, in practice.

a data-driven, personalized consultation

Help us tailor a data-driven analysis of what Direct Contracting could mean for your practice by providing a few key details.

We’ll follow up with a report and give you the opportunity to schedule a no-obligation consultation with one of our experts.