Essentials to Success In The CMS Direct Contracting Entity (DCE) PART 2: Provider Network Optimization

The Direct Contracting Entity program is further proof of the federal government’s commitment to value-based care, but most DCE participants are missing a significant savings opportunity: post-acute care.

Introduced in 2019 by the Center for Medicare and Medicaid Innovation (CMMI), the Direct Contracting Entity program (DCE) is building momentum in 2021. With 53 participants already in the program since its Jan. 2020 launch, CMS expects to add another 53 in 2022. Additionally, CMS has introduced the GeoDCE model, a geographic-based approach to care delivery, that launches Jan. 1, 2022. GeoDCE has also garnered a lot of interest from providers.

In the first article in this series, we discussed the importance of interoperability in DCEs. This edition focuses on another critical success factor: provider network relationships and management.

One of the unique components of the DCE program is that participating physicians and physicians’ groups can partner with downstream providers to align incentives and better manage the total cost of care. Most participants have formed alliances with multi-specialty groups and even acute-care hospitals, a significant first step. However, they have stopped short of the real opportunity: post-acute care (PAC).

“No other segment of care – except cancer treatment – creates more variability in the total cost of care equation than post-acute care,” said Mike Rawaan, Chief Strategy Officer at Post-Acute Analytics. “And where there’s variability, there’s opportunity.”

In a July 5, 2021 article, Alex Zorn of Skilled Nursing News points out that post-acute care providers are enthusiastic about participating in value-based programs. However, these organizations have few opportunities. That has changed with DCEs, one of the few value-based programs that offer a path to participation for post-acute care providers.

DCE presents an excellent opportunity to manage the variance that results from post-acute care utilization.

DCE participants have options when it comes to engaging post-acute providers. They can incentivize PAC providers to meet quality and outcomes targets or create high-performing provider networks and refer more PAC patients. In either scenario, it’s critical to know the right providers.

There’s a significant risk in creating a network based on financial incentives alone. Part of the variance in cost of care is due to a PAC provider’s quality of care and outcomes. To clearly understand how PAC providers perform on key metrics that drive better outcomes and lower costs, DCE participants must rely on data-driven solutions to help them objectively identify the right partners.

“There are many data-driven solutions out there, and most do a good job outlining how PAC providers in each of the four main care settings – LTACH, IRF, SNF, and HHA – perform with patients across different conditions.” said Rawaan.

“For example, most solutions can identify when a SNF produces low 30-day readmission rates for congestive heart failure patients but performs very poorly on the same KPI with stroke patients. However, understanding a PAC’s overall performance is only half of the calculation. It’s much more essential to know how they perform with your population. Acquiring this knowledge requires a deeper level of data analysis, which necessitates greater investment from DCE participants.”

Despite the high price tag, many data-driven solutions designed to help organizations select top providers only address the selection part of the challenge. Most platforms provide in-depth insights into provider performance based on historical data.

“While 6-8-month-old data can indicate how a provider is performing today, the key challenge with historical data is that it only allows providers to be reactive and hope to course-correct for the future,” said Mike Rawaan.

“This is where Anna, Post Acute Analytics’ proprietary, real-time, post-acute care management platform, differentiates from the rest of the PAC. Through its real-time connectivity into PAC providers’ EMRs, Anna can extract data in real-time – every four hours at the latest – and turn that data into insights that a clinical team can quickly react to and prevent high-cost clinical events, such as hospital readmissions.

“Anna also provides a real-time partner monitor dashboard that allows risk-bearing organizations, such as DCEs, to monitor the performance of their post-acute care provider partners in real-time and provide those PAC partner providers with the same insights to ensure consistency in performance.”

Post Acute Analytics currently supports eight of the largest health systems in the country with their value-based care arrangements.

Click here to discover how Post Acute Analytics has improved their current customers’ value-based care programs and how they can help you.

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