CMS Releases 2021 GPDC Results; APG CEO Praises Successes

Nov. 29, 2022
CMS last week released 2021 performance results for the Global and Professional Direct Contracting (GPDC) Model, eliciting praise from APG’s CEO for her member groups’ performance

The Centers for Medicare and Medicaid Services (CMS) on Wednesday, Nov. 23 released performance results from the Global and Professional Direct Contracting (GPDC) Model for calendar year 2021, with moderate but meaningful shared savings demonstrated by nearly three-quarters of organizations participating in the model. The results led to a statement praising the success of provider organizations participating in the GPDC Model on the part of the president of America’s Physician Groups (APG). What has been the GPDC was renamed the ACO Reach Model in February; the new year of ACO Reach begins on Jan. 1, 2023.

The results can be found here.

As CMS said in a statement last week, “CMS is releasing the Performance Year (PY) 2021 financial and quality benchmark performance results for the 53 Direct Contracting Entities (DCEs) that participated in the Global and Professional Direct Contracting (GPDC) Model in calendar year 2021, the first year of the model. In response to the public health emergency (PHE), the start of the Performance Year was delayed to April 1, 2021, leading to nine months of experience reflected in these results.

> DCEs in PY2021 generated approximately $119 million in gross savings. This is an approximately 3.3 percent gross savings rate relative to the retrospectively adjusted PY benchmarks (but before the 2 percent discount applied for DCEs in the Global risk option). After sequestration, total gross savings generated were ~$117 million.

> Net savings generated for Medicare based on the financial benchmark totaled approximately $70 million in PY2021 once the benchmark discount and shared savings arrangements were taken into consideration.

> Net payments to DCEs for Shared Savings/Losses totaled approximately $47 million relative to the PY2021 financial benchmark. This is an approximately 1.3 percent net savings rate for DCEs on average.

> Of the 53 DCEs participating in PY2021, 38 DCEs (72 percent) earned shared savings, while 15 DCEs (28 percent) incurred losses.

> A similar proportion (~70 percent) of DCEs in the Global and Professional risk options earned shared savings.

> Standard, New Entrant, and High Needs Population DCEs achieved 2.6 percent, 5.6 percent, and 11.6 percent gross savings rates on average, respectively; these DCE types achieved 0.7 percent, 3.4 percent, and 6.9 percent net savings rates on average, respectively. Note that these are aggregate averages (i.e., total savings across DCEs relative to benchmarks summed across DCEs) rather than an average of individual DCE rates.

> All 53 DCEs in PY2021 attained quality scores of 100%.

> 80 percent of the DCE quality score in PY2021 was assessed on a pay-for-reporting basis on purely claims-based measures; all DCEs received the full 80 percent.

> The remaining 20 percent of a DCE’s quality score was assessed on a pay-for-performance basis.  For PY2021, points were awarded if the DCE performed above the 30th percentile nationally on at least one of the quality measures. All (100 percent) DCEs in PY2021 met this threshold, and consequently every DCE received the full 20 percent on their quality score.

> For comparison, 92.9 percent of similar non-ACO/DCE entities met or exceeded the 30th percentile for at least one of the two quality measures.

> Starting in PY2023, 100 percent of a DCE’s quality score will be assessed on a pay-for-performance basis, and the performance percentile achieved will result in smaller or larger overall quality scores (vs. receiving full points for surpassing the 30th percentile).”

CMS officials said that “These results reflect performance against benchmarks calculated using observed national and regional spending trends and retrospective adjustments based on experience through the Performance Year. The Innovation Center also conducts a separate, independent evaluation of the GPDC Model. The financial results above reflect performance against a forecast informed by a historically aligned population, whereas the evaluation measures what happened in the GPDC population relative to a similar comparison group local to a DCE’s own aligned population whose care was not subject to the Model’s incentives.  The evaluation results for PY2021 are expected to become available in mid-to-late 2023.”

And the agency noted that “The GPDC Model is an initiative targeted at ACOs experienced in coordinating care for entire patient populations. The Model allows these provider groups to assume higher levels of financial risk and reward than those available under the Medicare Shared Savings Program. The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service beneficiaries.

While we do not yet have evaluation results, we are learning from our interactions with participants, and through the site visits we have been able to conduct, about the Model’s impact on beneficiary care. Among other design parameters, the Model’s payment mechanisms, benefit enhancements, and beneficiary engagement incentives have allowed providers to engage in creative care delivery strategies and benefit from the analytic support and infrastructure that DCEs provide. Participants report using care teams that consist of social workers and nurses to better support high-risk beneficiaries in their homes; they are also connecting beneficiaries to services, such as meal support and transportation, that address health-related social needs, and many are covering Part B cost-sharing as well.

As announced in February 2022, CMS has redesigned the GPDC Model to better align with the Biden-Harris Administration’s priorities and CMS’ vision for accountable care, and in response to feedback from stakeholders and participants. The redesigned model will be renamed the ACO Realizing Equity, Access, and Community Health, or ACO REACH, beginning January 1, 2023. Specifically, the ACO REACH Model addresses the following priorities:

> Greater focus on health equity and closing disparities in care;

> Emphasis on provider-led organizations and strengthening beneficiary voices to guide the work of model participants;

> Stronger beneficiary protections through ensuring robust compliance with model requirements, including increased screening of model applicants and increased monitoring of model participants;

> Greater transparency and data sharing on care quality and financial performance of model participants; and

> Stronger protections against inappropriate coding and risk score growth.

Value-based healthcare has evolved through the CMS Innovation Center’s model tests. Lessons learned from the GPDC Model will help define the future system of care. Our vision for the future is for a health care system that achieves equitable outcomes through high quality, affordable, person-centered care.

The release of information from CMS led the head of APG, which represents physician groups involved in risk-based and value-based contracting nationwide, to express pride in the result, particularly as they related to APG’s member organizations. “APG is pleased and proud that so many of our member organizations are among the 53 Direct Contracting Entities (DCEs) that recorded savings for the Medicare program, earned shared savings payments, and achieved perfect quality scores according to the Global and Professional Direct Contracting model metrics in the first performance year,” said Susan Dentzer, APG  President and CEO. “This important early evidence reinforces the concept behind this model: that its strong financial incentives encourage physician practices to transform care delivery; better manage and engage patients; and achieve higher quality-of-care outcomes than are typical for Medicare patients in the traditional fee-for-service program.” 

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