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CMS Seeks Applicants for Innovative Regional Care Model

December 09, 2020

The Centers for Medicare & Medicaid Services (CMS) is launching an innovative pilot program that will evaluate whether hospitals, health insurers, and other health care organizations can improve care and lower costs for Medicare beneficiaries across an entire geographic region.

The Geographic Direct Contracting Model, also known as “Geo,” builds off lessons from other CMS Innovation Center programs and continues federal initiatives to improve patient care while controlling costs. This new regional care delivery and payment model will evaluate participating hospitals, health plans, and accountable care organizations (ACO) during a six-year trial period.

The program requires participants to take the full risk with 100 percent shared savings/shared losses for Medicare Parts A and B services for Medicare patients in a defined target region. In return, health care organizations will receive added flexibility and incentives from CMS to create networks that meet a community’s specific local needs.

The program aims to provide the following benefits for Medicare patients:

  • Coordinate Better Care:  The program will emphasize the importance of preventive services and offer care management and clinical programs to support patients with chronic and serious illnesses
  • Improve engagement:  The plan will bolster access to telehealth services and home health care. It will also waive the three-day prior hospitalization requirement for skilled nursing facility care and offer incentives for accessing care management programs such as smoking cessation and weight loss programs
  • Lower Out-of-Pocket Costs:  Participants will have the option to reduce beneficiary out-of-pocket costs through reduced cost-sharing in Part A and Part B, as well as offering a Part B premium subsidy
  • Strong Beneficiary Protections: Beneficiaries will keep all the protections from Medicare, including access to all Medicare providers and suppliers, and strong CMS oversight

ACOs, health systems, provider groups, and health plans interested in this new model can submit a non-binding Letter of Interest to CMS by December 21. These letters will help determine where CMS solicits participants for the new program.

CMS has identified 15 Core Based Statistical Areas, each with between 150,000 to 700,000 beneficiaries. Philadelphia and Pittsburgh are among the 15 candidate regions identified.

Applications will be available during January and will be due on April 2. The first participants in will be selected by June 30, and the program will formally launch January 2022.

For additional information about this new program and other innovative delivery models, contact Kate Slatt, HAP’s vice president, innovative payment and care delivery.