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What Makes Direct Contracting The ‘Biggest Step Ever’ Toward Value Based Care

Updated: Mar 23, 2022

The Health and Human Services Secretary has referred to Medicare’s new care delivery model, the Direct Contracting Entity, or DCE, as the “biggest step ever” toward value-based care. But why?

Well, at Genuine Health Group, we agree the advent of the DCE marks a major shift toward expanding value-based care for a broader population of Medicare beneficiaries. That’s one reason we applied to CMS to create our own DCE, Genuine Health Direct.

In addition to significantly accelerating value-based care, Genuine Health Direct also offers our participating physicians the opportunity to bring greater financial consistency to their practices by earning monthly capitation payments. But, we’re getting ahead of ourselves. First, we want to make sure everyone reading this understands what a DCE is. That’s why we created this blog post: to answer the most common questions we hear about this new care model.

Why did Genuine Health launch a DCE?

Genuine Health Group has a long history of managing risk, and the launch of Genuine Health Direct allows us to apply this experience to keep our physicians’ patients healthy while they earn a monthly, prospective payment for the patients whose care they manage. Plus, we liked the fact that DCEs don’t restrict patients’ choice of providers.

How is Genuine Health Direct different than a Medicare Advantage plan?

Medicare beneficiaries aligned with Genuine Health Direct can access care from any provider who accepts Medicare – including specialists, because these patients are technically still enrolled in traditional Medicare. By contrast, members of Medicare Advantage plans must choose doctors and hospitals within their health plan’s network. In fact, many MA plans require referrals to specialists and have other restrictions.

Why do doctors like Genuine Health Direct so much?

As 2020 demonstrated, the healthcare industry can be unpredictable. Many doctors lost thousands of dollars of revenue during the early months of the pandemic – and even through later months – because their traditional Medicare patients didn’t come in for fee-for-service appointments. However, with Genuine Health Direct, doctors can count on a reliable monthly income. Like clockwork, they earn monthly capitation payments for their traditional Medicare beneficiaries aligned with the DCE. That’s very attractive to most physicians.

Are there any extra features patients can take advantage of with a DCE?

Patients aligned with Genuine Health Direct have access to additional services at no extra cost, such as health education, reminders for wellness visits, and support managing chronic conditions, like diabetes, high blood pressure, and COPD. In fact, Genuine Health Direct has a unique program called Genuine Health At Home that offers patients with chronic diseases in-home care and support, including help with medications, regular check-in calls, and even an evaluation of patients’ homes to eliminate dangers and hazards.

Is Genuine Health recruiting for its Direct Contracting Entity?

Yes, Genuine Health Group is currently recruiting high-performing primary care physicians for its new Direct Contracting Entity. And for these doctors, Genuine Health provides a wide range of practice support services, including assistance ensuring traditional Medicare patients in your practice align with Genuine Health Direct.

For more information about Genuine Health Direct, contact our Chief Growth Officer, Gamil Kharfan, at gkharfan@genuinehealthgroup, or call 786.878.5500.

The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.


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