NHPCO NewsLine Fall 2021 - 18

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▌ New Entrant DCEs are providers who do not have
as much experience serving Medicare beneficiaries
(only 1,000 beneficiaries are required to apply) but
are allowed to build their patient assignment as
the program grows.
▌ High Needs Population DCEs serve Medicare FFS
beneficiaries with complex needs through specific
care delivery strategies, such as PACE. The
number of beneficiaries required is even lower
than New Entrant DCEs (only 250 beneficiaries to
start) but needs to grow over time.
▌ Medicaid Managed Care Organization (MCO)
Based DCEs serve full-benefit dual eligible
beneficiaries. This model is also currently on hold
by CMS and under review.
While some hospice and other palliative care
organizations have built coalitions with other
providers and applied to be participants in DCEs or
DCEs themselves, this does require a high level of
sophistication and a very large population base. Other
organizations may choose to contract with DCEs as
preferred providers to provide a flexible hospice and
palliative care benefit. There are two contracting
options for providers looking to join a DCE:
▌ Direct Contracting Participant Providers share
patients with the DCE, must accept payment
from the DCE, must provide quality reporting,
and can benefit from shared savings.
▌ Preferred Providers do not share patients with
the DCE, can accept payment from the DCE, and
can benefit from shared savings.
More information on GPDC is available from CMS.
Private payer innovation - Private payers, including
Medicare Advantage (MA) providers are facing the
same pressures to increase quality of care, increase
provider satisfaction, and control costs. They are
taking some of the same approaches as CMS to
create this change, including building outcomeoriented,
holistic, community-based care models
paid on a value-based, predictable schedule. Just as
hospices and other palliative care providers can
bring value to CMS, they offer the same strength to
The better prepared hospices are
to offer services as payment
structures arrive, the better
positioned they will be
in that market.
private payer and provider systems. Where private
systems may not have the standardized structures
that CMS has, they more than make up for this
through their flexibility and willingness to find
one-off successes.
Future innovation, including a Palliative Care Benefit
- While we all know that making predictions can be
hazardous, there have been indications at CMS that
support for a federal palliative care benefit is
growing. Many private and Medicaid plans are
offering such a benefit already. The Medicare Care
Choices Model, a CMMI project that allowed
concurrent care for some hospice patients and that
demonstrated both savings and good patient
outcomes, is coming to an end by 2022 and a
palliative care benefit seems to be the next step for
CMMI. The timing of this is unknown but it is not
likely in the relatively near future.
The better prepared hospices are to offer services as
payment structures arrive, the better positioned
they will be in that market. It is vital that you stay up
to date on the latest innovations and never give up
on your advocacy efforts.
18
Newsline / Fall 2021
https://innovation.cms.gov/innovation-models/gpdc-model
NHPCO NewsLine Fall 2021

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