Direct Contracting Resources

Want to learn more about Pearl Health or Direct Contracting? Click on any of the links below to dive in.

Pearl Resources:

Today our special guest is Michael Kopko, CEO or Pearl Health (www.PearlHealth.com). This is the first interview inside our new 3-Part Series with Michael.

So if you’re a Doctor who takes care of Medicare fee-for-service (FFS) patients, then this topic is going to impact your practice and your patients whether you’re paying attention or not.

Patrick Mauro, Principal Data Scientist at Gordian Data and Advisor to Pearl Health provides an overview of CMMIs Direct Contracting benchmark and how understanding a practice’s key drivers can …

Pearl Health Chief of Staff Gabriel Drapos walks through an overview of the benefits of the CMS Direct Contracting Model and the ways in which Pearl Health is enabling independent physicians to …

Pearl Health leaders explore the ways in which previous efforts to transition physician …

Pearl Health President Ankit Patel gives an overview of the origin, successes and challenges of the value-based care programs  …

Pearl Health’s Liz Permenter and Justus Ruff talk about what they have learned from speaking with physicians across the country …

Center for Medicare and Medicaid Services (CMS)

The Center for Medicare and Medicaid Innovation (Innovation Center) is excited to announce that 53 Direct Contracting Entities (DCEs) are participating …

Direct Contracting (DC) is a set of voluntary payment model options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS) …

The Direct Contracting Model creates a new opportunity for the Centers for Medicare & Medicaid Services (CMS) to test an array of financial risk-sharing …

New performance year benchmark methodologies focused on increasing benchmark stability, simplicity, and prospectivity …

Financial model that supports broader participation by entities new to Medicare Fee for Service (FFS) and/or focused on delivering care for high needs populations …

Other Resources:

Before I started research for this newsletter, all I knew was that value-based care models can be contentious, and that they almost always seem contentious for insider-baseball …

The federal CMMI was created to assess new payment and service delivery models for improving health care nationwide. This review reports that during the agency’s first decade of operation …

Over the past decade, Medicare has tested care coordination programs in an effort to achieve the triple aim of improving the patient experience …

The financial benchmark in the CMS Direct Contracting (DC) payment model will share key attributes with the Medicare Shared Savings Program (MSSP) financial benchmark. In this white paper, we compare and contrast …

The COVID-19 pandemic has impacted every aspect of life in the US and challenged the capacity of the health care system like no other event in modern times …

In 2018, the US spent $3.6 trillion on health care. That’s a lot of money. But where this money goes and variation in spending is not well understood …

The Coalition is an opportunity for participants to exchange information, share best practices, and collaborate on advocacy opportunities that will strengthen the experience in the Direct Contracting Model.

Because hospitals and health systems sponsored the majority of new accountable …

New analysis from Avalere finds that physician-led accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) outperformed hospital-led ACOs by a significant margin.

Over the last decade, the role of Medicare Advantage, the private plan alternative to traditional Medicare, has grown. In 2021, more than 26 million people are enrolled in a Medicare Advantage plan, accounting for 42 percent of the total Medicare population,

Most healthcare costs are concentrated in a small proportion of individuals with complex social, medical, behavioral, and clinical needs that are poorly met by a fee-for-service healthcare system. 

When corporate executives, health care leaders, and policy makers discuss the challenge of curbing U.S. health care costs, the conversation invariably turns to the sickest 5% of the population, who consume 50% of health care spending. For a long time the hope has been that improving the efficiency and quality …

TLDR: 1) Voluntary models don’t work 2) Clear focus on primary care going forward 3) Where Medicare goes so goes the rest of healthcare.

Sg2 Experts Explain CMS’ Direct Contracting Program:

Part 1 gives an overview of the program and how it works, including the application process. Find out how Sg2 can help your organization with Direct Contracting …

Part 2 gets into more details including participant providers, preferred providers, and organization types …

Part 3 covers payment mechanisms. Find out how Sg2 can help your organization with Direct Contracting …

Part 4 covers benchmarking methodology. Find out how Sg2 can help your organization with Direct Contracting …

Part 5 tackles quality waiver requirements …

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