CMS is also committing to greater transparency by releasing more information on current GPDC Model participants available here (PDF) and is strengthening monitoring to ensure beneficiaries whose providers participate in the model continue to receive high-quality, patient-centered care during 2022 and beyond.
In addition, CMS is permanently cancelling the Geographic Direct Contracting (Geo) Model, which has been on hold since March 2021. The Geo Model is being canceled because it does not align with CMS’ vision for accountable care and concerns raised by stakeholders.
The Global and Professional Direct Contracting (GPDC) Model is a voluntary, Accountable Care Organization (ACO) model designed to put patients at the center of their care. Building upon lessons-learned from initiatives involving Medicare ACOs, such as the Medicare Shared Savings Program and the Next Generation ACO Model, this model provides greater individualized attention to a beneficiary’s specific health care needs within Original Medicare, and changes financial incentives to reward high quality care.
The GPDC Model also aims to improve beneficiaries’ experience of care. Beneficiaries may be aligned to an entity participating in the model if they choose (or already have) a primary care doctor who is part of a Direct Contracting Entity (DCE – another word for ACO) participating in the model. Beneficiaries maintain the right to opt out of model-related aspects of care and can elect to see any provider they choose without being restricted to a network. Beneficiaries aligned to DCEs participating in the GPDC Model may benefit from aspects of the model such as increased access to telehealth and in-home skilled care for beneficiaries who are not otherwise eligible for home health services. All beneficiaries who are aligned to a DCE in the GPDC model remain in Original Medicare and retain all of their rights and privileges, including the freedom to see any Medicare provider.
The GPDC Model benefits participating organizations by reducing practices’ administrative burden, allowing health care providers greater flexibility in how they deliver care, and rewarding them for improving quality. By tying payments to improvements in the quality of care provided, health care providers are incentivized to collaborate across multiple treatment plans, spend more time with patients with complex, chronic conditions and ultimately, improve patient health outcomes.
The Model's goals are to:
- Transform risk-sharing arrangements in Original Medicare by tying payment to the quality of care provided to patients and reducing total expenditures through partially capitated payments that move away from traditional fee-for-service.
- Empower beneficiaries to engage in their health care with support from DCEs that help them to navigate the complex health care system. The model offers many additional flexibilities for beneficiaries, such as making in-home care management visits available when a patient is at high risk for hospitalization.
- Reduce provider administrative burden so that they can focus on what is most important: spending time with patients. For example, participants are able to report quality measures that focus more on outcomes and beneficiary experience in lieu of measures that focus on process. As a result, the providers can spend more time focused on the specific and individualized needs of their patients.
The GPDC Model was designed to provide new opportunities for a variety of different health care organizations and physician practices to participate in value-based care arrangements in Original Medicare. Under the model, there are three types of participants with different characteristics and operational parameters:
- Standard DCEs - DCEs comprised of organizations that generally have experience serving Original Medicare patients, including Medicare-only and also dually eligible beneficiaries, who are aligned to a DCE through voluntary alignment or claims-based alignment. These organizations may have previously participated in another CMS Innovation Center shared savings model (e.g., Next Generation ACO Model and Pioneer ACO Model) and/or the Shared Savings Program. Alternatively, new organizations, composed of existing Original Medicare providers and suppliers, may be created to form a Standard DCE. In either case, clinicians participating within these organizations would have substantial experience serving Original Medicare beneficiaries.
- New Entrant DCEs - DCEs comprised of organizations that have not traditionally provided services to an Original Medicare population and who may rely primarily on voluntary alignment, at least in the first few performance years of the model. Claims-based alignment will also be utilized.
- High Needs Population DCEs – DCEs that serve Original Medicare patients with complex needs, including dually eligible beneficiaries, who are aligned to the DCE through voluntary alignment or claims-based alignment.
- These participants are expected to use a model of care designed to serve individuals with complex needs, such as the one employed by the Programs of All-Inclusive Care for the Elderly (PACE), to coordinate care for their aligned beneficiaries.
There are two voluntary risk-sharing options under the GPDC Model. In each option, participating providers accept Medicare claims reductions and agree to receive at least some compensation from their DCE.
- Professional. A lower risk-sharing arrangement—50% savings/losses—with one payment option for participants: Primary Care Capitation Payment, a risk-adjusted monthly payment for primary care services provided by the DCE’s participating providers.
- Global. A higher risk sharing arrangement—100% savings/losses—with two payment options: Primary Care Capitation Payment (described above) or Total Care Capitation Payment, a risk-adjusted monthly payment for all covered services, including specialty care, provided by the DCE’s participating providers.
Information for Active DCEs
CMS has determined that, beginning April 1, 2021, the anti-kickback statute safe harbor for CMS-sponsored model arrangements (42 CFR § 1001.952(ii)(1)) is available to protect certain DCE financial arrangements between or among the DCE, one or more DC Participant Providers, one or more Preferred Providers, or a combination thereof, provided that such arrangements comply with the requirements set forth in Section 3.04.M.1 of the GPDC Model Performance Period Participation Agreement (“Participation Agreement”). (Unless otherwise specified, capitalized terms have the meaning set forth in the Participation Agreement.)
Further, CMS has determined that, beginning April 1, 2021, the anti-kickback statute safe harbor for CMS-sponsored model patient incentives (42 CFR § 1001.952(ii)(2)) is available to protect certain in-kind patient incentives and Beneficiary Engagement Incentives furnished by a DCE, DC Participant Provider, or Preferred Provider to a Beneficiary or DC Beneficiary (as applicable), provided that such incentives are furnished in a manner that complies with the requirements set forth in Section 5.08.B of the Participation Agreement.
The GPDC Model will be an Advanced Alternative Payment Model (APM) starting in its first performance year (PY2021).
Transparency and Data Sharing
CMS recognizes that stakeholders are interested in information about models, including greater insights into the participants, what they are doing to improve care, and impacts on quality and costs in advance of evaluation results being published. CMS is committed to providing greater transparency into the GPDC Model.
For the GPDC Model, CMS is sharing the following information, regarding each DCE participating in the model:
- Type of entity (Standard, New Entrant, High Needs),
- Risk-sharing arrangement (Global or Professional)
- Payment option (Primary Care Capitation, Total Care Capitation, Advanced Payment),
- Benefit enhancements and beneficiary engagement incentives they have selected to use (e.g., care management home visits to prevent hospitalization, waiver of the Medicare homebound requirement for access to home health services, Part B cost sharing support),
- Organization website, and
- Core service area.
CMS will also share aggregate information for all DCEs on quality and financial performance based on operations data and financial benchmarks, not evaluation, which will be updated quarterly. It is important to note that the quality information presented will be for two claims-based measures—All Cause Readmissions and Unplanned Admissions for Multiple Chronic Conditions. In addition, information will be shared on the payments being made to DCEs on a quarterly basis.
Refer to the GPDC Model Participant Overview and the Quarterly Summary of Quality Performance, Financial Performance, and Model Payments in the Information for Interested Stakeholders section below for this information and data.
Information for Interested Stakeholders
NOTE: Any information referencing GPDC beyond December 31, 2022 is outdated. Please see the ACO REACH model page for information about the model’s future.
If you are interested in receiving additional information and updates specifically about the GPDC Model, please subscribe to the GPDC Model listserv.
If you are interested in receiving CMS Innovation Center updates, including about GPDC, subscribe to the CMS Innovation Center listserv.
For any questions, please email the GPDC Model team at DPC@cms.hhs.gov.
- PY22 GPDC Model Participant Overview (PDF)
- Quarterly Summary of Quality Performance, Financial Performance, and Model Payments (PDF) - updated 8/15/2022
- Request for Applications (RFA) (PDF) - released November 2019 for PY2021/PY2022 participation
- Frequently Asked Questions - April 2021 (PDF)
- First Implementation Period Participants (PDF)
- Second Implementation Period Participants (PDF)
- PY2021 Participants (PDF)
- Model Overview for State Insurance Regulators
- GPDC Model Archived Materials
- For Consumers: What is Accountable Care and What are Accountable Care Organizations?
- Financial Frequently Asked Questions - April 2021 (PDF)
- PY2022 DC/KCC Rate Book (XLS)
- PY2022 DC/KCC Rate Book Development (PDF)
- PY2022 DC/KCC Risk Adjustment (PDF) - updated 2/24/2022
- PY2022 Financial Operating Guide Overview (PDF) - Updated 12/1/2021
- PY2022 Capitation and Advanced Payment Mechanisms (PDF)
- PY2022 Financial Reconciliation Overview (PDF)
- PY2022 Quality Measurement Methodology (PDF) - Updated 8/15/2022
- PY2021 Financial Papers (Archived Materials)
- Webinar: Direct Contracting Model Options - Professional and Global Options Overview (12/11/2019)
- Webinar: Direct Contracting Model Options - Benefit Enhancements (12/18/2019)
- Webinar: Direct Contracting Model Options - Payment Part One (1/15/2020)
- Webinar: Direct Contracting Model Options - Payment Part Two (1/22/2020)
- Call: Direct Contracting Model Options - COVID-19 Flexibilities (6/4/2020)
- Webinar: Direct Contracting Model Options - Financial Methodology (9/18/2020)
- Webinars: Direct Contracting Model Options - Overview Series
- Webinar: Direct Contracting Model Options - Professional and Global Options Financial Methodology Reconciliation (12/17/2020)