A new program launched by CMS called the Global and Professional Direct Contracting Model is an experimental program to help decrease the cost of healthcare. This program will provide 50 start-ups with thousands of patients and a controlled budget to care for that patient’s healthcare needs. The program is scheduled to last 6 years and the proposed winners must decrease the cost of care and improve the health of those enrolled.

Healthcare costs continue to rise and Medicare alone is expected to reach $1.5 trillion in 2029 which is a stark increase from the $782 billion back in 2019. The work to move towards a value-based system has been slow and difficult. The projected revenue for those companies that are enrolled is expected to be in the tens of millions.

Some of the challenges these companies face include the cost of specialty and hospital visits because the patients that are enrolled in this program do not have a network. The other challenge that these companies face is being able to apply to earn cost savings because they will not be able to receive more money for higher patient risk scores. According to the article linked below, the benchmark cost is more accurate than in previous years, but only time will tell if this method will be successful.

Are you in direct primary care? Would you be interested in working with Medicare patients under this system? What questions do you have about the challenges or advantages these organizations or providers will face?

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