- CMS is rolling out a new direct contracting model for Medicaid managed care organizations covering dual eligibles, those enrolled in both Medicare and Medicaid, to improve care and reduce overall spending.
- The goal is to provide MCOs new incentives that are currently absent from the program, CMS said Thursday.
- The model has two risk-sharing options: either 50% shared savings and losses, or the ability to take on full risk.
The dual eligible population is quite costly to the Medicare program and changing up incentives may help reduce spending over the long term. The dual eligible population often has multiple complex health conditions and while they only represent a portion of enrollment, the group represents 34% of all Medicare spending.
Currently, there is no incentive for an MCO to deliver care in a way that reduces costs in Medicare fee-for-service. Any savings that an MCO currently generates from members in Medicare fee-for-service accrues back to Medicare — not the MCO.
The new model will allow MCOs to share in a portion of the savings they may generate, CMS said, encouraging MCOs to provide a wide range of care, hoping to avoid costly events.
These MCOs may choose to offer benefits like providing in-home aides to coordinate care or meals, and can encourage members to get a flu vaccine and other preventative services.
The possibility of shared savings may spur MCOs to make these sorts of investments and others, CMS said.
MCOs may begin participating in the model in 2022 after a request for applications process, which is set to begin in early 2021.