What is Voluntary Alignment in Global & Professional Direct Contracting (GPDC)?

Charles Gillock

Charles Gillock

Senior Market Success Manager

Voluntary Alignment | Globbal and Professional Direct Contracting (GPDC)

Voluntary Alignment explained

Direct Contracting marks an important development in value-based care. A flexible platform aimed at improved clinical outcomes and reduced Total Cost of Care (TCOC), the model incentivizes primary care providers to deliver only the highest quality of care to their Traditional Medicare patients while achieving economic efficiencies that are critical to an overburdened Medicare trust fund. One feature of this arrangement in particular — Voluntary Alignment — can empower patients to play a larger role in their own care journeys, while enhancing physicians’ ability to effectively manage their panels and grow their practices. 

Historical Context for Alignment

It is important to understand Voluntary Alignment in the context of value-based care broadly. Value-based models are built on a commitment to a panel of patients determined by attribution, typically from claims. Claims-based alignment has traditionally had two flavors — prospective and retrospective. Prospective alignment sees beneficiaries assigned to a risk-bearing organization (like an Accountable Care Organization, also known as an “ACO”) based on services administered prior to the performance year in question. Conversely, retrospective alignment assigns beneficiaries based on services occurring during the performance year. 1

Claims-based alignment has limitations. Many patients do not have a clear pattern in claims that allows them to be attributed to one physician. Moreover, the nature of claims-based alignment is at odds with patient choice beyond its implicit look-back nature. Although claims-based alignment affords more patients the opportunity to participate in value-based arrangements, and makes participation in these models easier for providers, there has been a clear need to outfit populations with more choices. 

Benefits of Voluntary Alignment

Enter Voluntary Alignment. The Centers for Medicare and Medicaid (CMS) first introduced Voluntary Alignment for all Medicare programs in 2017 in an effort to encourage beneficiaries to take a more active role in their care. Functionally, patients can voluntarily align with a primary care physician of their choosing by either

  1. Visiting mymedicare.gov (Electronic Voluntary Alignment); or
  2. Filling out a form and turning it in to their provider (Paper Voluntary Alignment).

These processes provide a simple method of accounting for patients in the race to value. Depending on elections by the Direct Contract Entity (DCE) in question, patients can either be aligned annually or quarterly, joining the provider’s panel during the performance year or in the following year. 

For Patients: Benefits of Voluntary Alignment

Voluntary Alignment has many advantages for patients and providers alike. For patients, declaring a primary care physician yields greater control over care and allows patients to benefit from the various programs a value-based entity may choose to enact. In contrast to other value-based programs like Medicare Advantage, Voluntary Alignment under Direct Contracting allows patients to align with a DCE’s participating provider — depending on the DCE in question’s policies — during the performance year.

This feature grants patients access to enhanced benefits like dental vouchers, reduced co-pays, and meals as medicine in shorter order than aforementioned programs that only allow annual enrollment. Further, studies have shown that increased patient involvement in care decision making improves satisfaction and outcomes.2 Voluntary Alignment allows patients to seize control of their care by dictating their provider of choice, increasing involvement in care decisions and forging a close relationship that can improve outcomes and satisfaction for all parties. 

For Providers: Benefits of Voluntary Alignment

For providers, Voluntary Alignment enables greater coordination of care, promoting enhanced clinical success and more efficient transitions of care. Aligned beneficiaries are more inclined to share their status with their provider, particularly in the event of receiving care outside of their normal geography. Enhanced visibility into their patient panel also gives providers a leg up on developing care plans. Additionally, adding attributed patients increases both the monthly Per Member Per Month (PMPM) paid to providers in Direct Contracting and shared savings potential at the end of year, creating a financial incentive for providers to help account for patients. 

For the U.S. Healthcare System: Benefits of Voluntary Alignment

Overall, Voluntary Alignment has the potential to pay dividends for the U.S. healthcare system as a whole. Primary care physicians are experts in managing multiple treatments, medications, and the interactions between those channels. Good primary care can save tremendously on downstream spending by improving providers’ ability to affect prevention, coordination, and steerage. Aligning patients with their primary care provider of choice can reduce healthcare spending, improve outcomes, and pave the way for a more coordinated and efficient healthcare system. 

Process and Considerations

At Pearl Health, we’re excited to work with our physician partners to help them succeed in Direct Contracting. Voluntary Alignment is just one of the many exciting features of this revolutionary model that has massive potential to improve outcomes and lower costs across the board.

Last but not least, here’s a resource on Voluntary Alignment in the Learning Center of the Pearl Platform. Contact us to learn more about how to get early access.

Explore more resources like this by visiting Pearl’s blog.

1 https://www.milliman.com/-/media/milliman/pdfs/articles/prospective-retrospective-assignment-mssp-beyond.ashx

2 https://www.healthcarevaluehub.org/advocate-resources/publications/consumer-benefits-patient-shared-decision-making

3 https://www.naacos.com/assets/docs/pdf/2020/VoluntaryAlignmentFAQs.pdf

4 https://www.apg.org/wp-content/uploads/2021/05/DC-Coalition-Letter-to-HHS-on-Direct-Contracting-FINAL-5.17.21.pdf

5 https://innovation.cms.gov/innovation-models/gpdc-model

6 https://www.milliman.com/-/media/milliman/pdfs/articles/prospective-retrospective-assignment-mssp-beyond.ashx