The Centers for Medicare and Medicaid Services (CMS) has been trying to bend the cost curve by testing payment models to counter the standard fee-for-service model. Its latest iteration put forward through the Centers for Medicare and Medicaid Innovation (CMMI) is the Direct Contracting Entity (DCE) model.

value-based care-direct contracting entities providing care services to medicare beneficiaries

The standard DCE model is CMMI’s next-generation Alternative Payment Model (APM). The model builds on what CMMI learned from its experiences with Accountable Care Organizations (ACOs). Like with ACOs, the DCE model seeks to incent healthcare providers to improve quality outcomes and move from fee-for-service to value-based payment.

With the standard DCE model, CMMI hopes to encourage a wider range of providers into the performance-based risk arrangement model. Particularly, CMMI is targeting physicians and medical groups that usually provide care services mostly to Medicare Advantage beneficiaries.

These medical and physician groups largely haven’t been able to participate in the previous generation APMs for several reasons, including that they couldn’t meet benchmarks, often because their practice sizes were just too small.

timeline implementation of dce model

The new DCE model lowers beneficiary benchmarks, reduces core quality measures, and offers more financial flexibility than previous models, making participation by these groups more viable and palatable.

While participation standards have been reduced as compared to previous value-based payment models, DCEs are still required to satisfy performance criteria set by CMMI. DCEs can select from three types of risk-sharing tracks, each with its own specific set of quality metrics and benchmarks to be met and risk-adjusted payment to match.

To improve quality outcomes for their patients while reducing costs, DCE models must work with their care partners and suppliers to better coordinate care and reduce administrative burden and work with their patients to better engage them in their health.

Meeting these goals will require investment in innovative healthcare management technologies. These include software programs that can calculate benchmarking data and forecast performance. They also include technologies that enhance patient care, such as telemedicine, remote monitoring, and home care supports.

cms will assess applications according to the five specific criteria

Mobisoft’s digital healthcare solution can help DCE models to engage patients in their healthcare and improve health outcomes. This app simplifies and streamlines appointment booking by letting patients or their care team help to book an appointment through the app from wherever they are, at any time of day. They can also use the app to cancel and reschedule appointments. Making it simple and easy for patients to book appointments reduces the administrative burden on clinic office staff, and means patients are more likely to show up for their appointments and get the care they need for immediate health issues and preventive care, keeping them out of more expensive care options, such as the emergency department.

Mobisoft’s HIPAA-compliant all-in-one software platform offers patients virtual, in-person, or house call visits with their physicians or other health providers. This comprehensive digital healthcare solution connects patients with their providers by allowing them to self-book appointments, offers secure messaging, and keeps the patient’s history in one place, accessible to the providers and staff who need it. Optional features allow for EHR integration and prescription and medication tracking. The platform’s reporting and analytics features make it easy to aggregate data to support benchmarking and quality metrics goals.

Mobisoft even has software solutions to help address patient barriers to care, such as not being able to get non-emergency transportation to medical appointments and food insecurity issues.

Mobisoft’s NEMT Dispatch software app is a cloud-based solution that streamlines patient transportation requests and incorporates dispatching, scheduling, billing, and client management tools all in one place, and its meal delivery app can get restaurant meals or groceries to your housebound patients.

Value-based care is revolutionizing the way care is needed to be delivered by ACO, MCOs, and Primary Care Providers

Wrapping Up,

Mobisoft has a software program that will help DCE models determine what the most pressing social determinants to health are among their patients, and can provide care collaboration networking with social and community resources to help improve the everyday conditions of their patient’s lives, which in turn can aid in improving healthcare outcomes.

With these options and others, Mobisoft provides the custom-built and end-to-end mobile technology solutions DCEs need to help them achieve their value-based care goals.

Provide annually and community-based resources via our care coordination and patient engagement platform Get in touch with us for a detailed discussion

Author's Bio

Ayushi Patel Mobisoft Infotech

Ayushi Patel

Ayushi Patel is the Director of Strategy & Innovation at Mobisoft Infotech. She leads the strategic partnerships and initiatives in the healthcare division. Her experience includes healthcare administration, business development and sales, and customer success management.