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CMS innovation agency to launch risk-based model for dual eligibles


Wikipedia Dive Brief:

CMS’ innovation center is about to roll out a new model allowing insurance plans to take on financial risk for patients enrolled in both Medicare and Medicaid, Brad Smith, director of the Center for Medicare and Medicaid Innovation, said Tuesday at payer lobby AHIP’s virtual conference.

The trial will allow managed care organizations that assume risk for a patient enrolled in Medicaid to also assume risk for that same patient in fee-for-service Medicare.

Along with the dual-eligible demonstration, Smith said industry could expect some additional models to come out of the pipeline in the next few months, including one letting plans and providers take on risk for Medicare lives in certain geographies.

Dive Insight:

Allowing payers to assume risk for a dual-eligible population is an idea CMMI has toyed with before, Smith said at the AHIP National Conference on Medicare, Medicaid and Dual Eligibles. The upcoming trial will be based on CMMI’s direct contracting model, which offers capitated payments for Medicare FFS beneficiaries through partial or full downside risk.Generally, Medicaid managed care organizations get upfront fixed payments from states, based on expected utilization of covered services, administrative costs and profit for their patient population. By comparison, […]

read more here —> www.healthcaredive.com

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