What Is Direct Contracting?

Direct Contracting is a new payment model from CMS that enables the creation of DCEs (Direct Contracting Entities). Pearl Health identifies opportunities for providers to participate in Direct Contracting and gives them the tools necessary to succeed.

DCEs will enable participants to transition their Traditional Medicare populations to value-based care via a capitated reimbursement model, creating a predictable flow of revenue.

Through this initiative, Pearl will be able to support primary care providers in the delivery of care as it should be – to deliver better care, reduce health care costs and provide better financial support to primary care providers.

doctor filling out paperwork

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

The DCE model improves on other value-based programs by offering added flexibility and support for primary care providers delivering care to patients enrolled in Traditional Medicare. The flexibility afforded to primary care physicians participating in a DCE include:

dollar sign with three upward arrows signifying enhanced revenue opportunities

Enhanced revenue opportunities for primary care providers, including fixed, capitated payments

dollar sign with downward arrow signifying reduced patient cost

Reduced patient cost sharing and out-of-pocket expense

cartoon man symbolizing easy access to post-acute providers

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

Learn More About
Why Direct Contracting
is Different

Why You Are Probably Frustrated with Value Based Care (VBC):How Direct Contracting is Different:
“The VBC attribution list excludes many patients whom I am caring for.”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) eliminates 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.”Direct Contracting Entitles can build a preferred network of providers with lower cost sharing, 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.”Direct Contracting Entitles can be stratured to pay providers a fixed per-member-per-month giving revenue stability and the cash flow needed to invest in patien care.
“Most VBC programs have burdensome and costly quality reporting requirements.”The DC program’s quality measures are based on claims and patient satisfaction surveys, not complicated data submissions.

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To receive more information about our model and how you can participate in this program, please provide us with some information about your practice so that we can reach out with additional details.

If you like what you read, we can provide you with a free, personalized analysis of what Direct Contracting could look like for you.