Become a DCE Member

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

• Receive a predictable PMPM for my traditional Medicare panel 
• Reduce administrative and billing overhead 
• Participate in the overall shared savings of the group
• Utilize local care management services like Care Management, Complex Case Management, Home Health like and Hospice like services, provided by the DCE
• Receive 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.

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.

This will be based on a weighted algorithm, which will be calculated similarly to the initial PMPM payments you receive. This calculation will be based on acuity (patient’s pre-existing conditions and  total cost of care) and your total number of lives in the DCE model.

Your total reimbursement will vary based on performance.

The first 6 months will be a flat capitation payment (think of this as a guarantee).

On a quarterly basis thereafter, we will then adjust the PMPM based on your performance and the patient data collected in the first half of the year.

DCE’s can earn additional revenue through shared savings. Medicare establishes a total-cost-of-care target for Participating Providers, based on the costs associated with the historical claims for their Traditional Medicare patient panel, the disease burden of that panel, and the regional costs of services – this is called ‘the benchmark’. DCE’s whose costs are below their benchmark in a given performance year will receive a portion of the savings they helped generate. The Participant Agreement with providers carries no downside risk for the providers who participate in the GPDC Elation DCE network.  (where providers are not responsible for repaying Medicare for any losses they incur).

There is no cost to Participating Providers, Preferred Providers or their beneficiaries to participate in a DCE.