Become a DCE Member Receive financial and administrative benefits for your traditional Medicare patients. By participating in Elation’s Direct Contracting Entity you maintain full control over the care of your patients. Book a Meeting Now Benefits Receive a predictable PMPM or enhanced FFS schedule for your traditional Medicare panelReduce administrative and billing overheadUtilize local services like Care Management, Member and Provider Relations, provided by the DCE Timeline September 10, 2021Deadline for PCPs to join Elation DCESeptember 10, 2021 November 10, 2021Deadline for preferred providers (non-PCPs) to join Elation DCENovember 10, 2021 January 1, 2022Reporting year and payment cadence beginsJanuary 1, 2022 June 30, 2023Final Medicare reconciliation will completeJune 30, 2023 About Medicare DCE’s How does a DCE compare to an HMO? The DCE program maintains Medicare’s open access, so it does not require narrow networks or the utilization management overhead that have been challenges to physicians and patients in HMO models. How does the DCE compare to previous Medicare programs like Primary Care First or CPC+? The DCE model is a replacement to those programs, for physicians who choose to align their patient panel to the DCE. The program provides additional stability in the PMPM payment model, and Elation’s services will provide administrative support to reduce reporting requirements and overhead. What is a DCE? A Direct Contracting Entity (DCE) is a specific type of Accountable Care Organization (ACO) focused on the Medicare direct contracting program. Participating in a DCE allows practices to earn a PMPM in place of fee-for-service Medicare reimbursement, and typically gives the participating practices access to programs that invest in their success through products, analytics and services to help them manage their patient panels. What is Direct Contracting? Direct contracting is a Medicare value-based care program, allowing CMS to test new ways for controlling the costs of care for Traditional Medicare patients while maintaining high quality. Primary Care Providers (PCPs) receive fixed monthly payments (PMPM) for managing the primary care needs of their traditional Medicare beneficiaries and share in the savings they help generate on those patients. About Elation DCE What are the key dates? Physicians can join the Elation DCE until September 10th, 2021. The reporting year and payment cadence begins January 1st, 2022. The final Medicare reconciliation will complete in June 2023. What services will Elation DCE provide? Yes. Elation DCE plans to provide both local and centralized services to help physicians transition to these value-based models and succeed in the program. In addition to EHR subsidies, Elation DCE will provide analytics and management tools to assist participating providers with reporting, regulatory compliance, and improved panel management. Our local services will include support for patient outreach (Member Relations), account management for your clinic (Provider Relations), care coordination for at-risk patients (Care Management), and case management for complex patients as needed (Complex Case Management). All of these services – MR, PR, CM, CCM – are included without additional fees for participants in the DCE. What is Elation DCE’s business model? PCPs get a guaranteed per patient per month payment as participants in the DCE, while specialists get a percent increase on the baseline Medicare FFS schedule. Elation DCE is the party taking risk on the Medicare population, in exchange for 95% PBPM and 100% of the shared savings at the program’s conclusion for those Medicare beneficiaries aligned with Elation DCE. What is Elation DCE? Elation is participating in CMS CMMI’s Global & Professional Direct Contracting Model (GPDC) via the Elation DCE. Elation DCE will be managing and accepting operational and financial responsibility for the DCE program for aligned patients. Participating in Elation DCE Can I see patients outside of the DCE? If you are serving as the primary care doctor for a Medicare patient, and the patient acknowledges this, then that patient will be part of the DCE program. You can also have patients outside of the DCE program with commercial payers, other Medicare programs (like Medicare Advantage), or direct payment models. The DCE alignment only applies to your traditional Medicare panel. How does participating in the DCE affect my patients? Patients who become part of a DCE, through their primary care physician, will retain their Traditional Medicare rights and benefits, and DCEs are required to inform them of this at the outset of the Performance Year. When you join a DCE as a Participating Provider, Medicare will look at the history of your claims submissions for the last few years and determine the patients you have been providing care to and enroll them in the DCE. Additional Medicare patients can also select you as their PCP, which will enroll them into the DCE as one of your patients at the start of the following quarter. This process is known as ‘aligning’ a patient to you and means that you will receive credit for managing the care of that patient. The cost of their primary care services will be included in determining your monthly capitated payment and their total-cost-of-care in each year of the program will be part of the calculation to determine whether you benefit from having generated savings. I’m in an ACO, can I participate in Elation DCE? Participating Providers (i.e. PCPs) cannot participate in both a DCE and a Medicare ACO. CMMI recently announced that they are sunsetting the NextGen ACO program, and have recommended that providers who were successful in that model consider Direct Contracting. Participating in a DCE has no effect on your commercial ACO participation. Preferred Providers (i.e. specialists) can participate in multiple CMMI value-based models. What are the benefits of participating? Receive a predictable PMPM for my traditional Medicare panel Reduce administrative and billing overhead Participate in the overall shared savings of the groupUtilize local care management services like Care Management, Complex Case Management, Home Health like and Hospice like services, provided by the DCEReceive a subsidized EMR (Elation) and reporting solution High performing practices can often earn more in a Direct Contracting Entity while benefiting from the stability offered by the monthly, fixed primary care payment. Many providers favor the flexibility and lessened administrative burden offered by the Direct Contracting model. Who can participate? Any provider who accepts and is in good standing with Medicare can join a DCE to participate in the program. This includes providers with closed panels. Primary Care Providers with Traditional Medicare beneficiaries can become Participating Providers, and their patients automatically join the DCE when they do and receive all of the benefits of being in the DCE. Other providers (e.g. specialists, ancillary facilities, suppliers, etc.) can become Preferred Providers, which indicates that the provider and the DCE are aligned to generate savings. DCE beneficiaries may receive incentives to go to a Preferred Provider such as copay or coinsurance reduction. Am I still required to participate in MIPS? Short answer, Participant Providers (PCPs) are exempt, Preferred Providers (non-PCPs) are not exempt. DC Participant Providers who are on the DCE’s provider list submitted to CMS are eligible to become a Qualifying APM Participant (QP) for a Performance Year. Beyond being on the provider list, these DC Participant Providers must meet the thresholds required by the QPP. If they meet one of the required thresholds, they will be entitled to an APM Incentive Payment and exempt from MIPS reporting requirements and payment adjustments. However, Preferred Providers are not eligible for QP status under the Direct Contracting Model.