How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?

July 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Categories:   Risk Adjustment    Coding  
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CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare improve health outcomes for beneficiaries while improving the financial stability of the Medicare program.

This model of in-home primary care is focused on caring for medically complex patients with an emphasis on improving health outcomes through proper in-home monitoring of medications, activities of daily living, and social determinants of health, while also reducing inpatient hospitalizations by gaining a deeper understanding of environmental and health factors. Clover aims to achieve these goals with a strategy that includes:

  • A strong focus on monitoring social determinants of health, such as the patient’s living environment and access to nutritious food
  • At-home evaluation and technology options 
  • Identification and organization of medications to reduce polypharmacy or overdose
  • Collaboration with family members and other caregivers
  • Transitional care services following hospital discharge to prevent readmission
  • Individualized care plans and in-person access to trusted primary care providers who will communicate with the beneficiary’s provider, if desired.

Clover differs from the common brick-and-mortar or home health care models that rely on the documentation of a member’s health conditions over a focus on improving clinical outcomes and through the process of direct contracting with the CMS GPDC program, we may yet see additional companies providing specific, focused care for Medicare beneficiaries that may produce more accurate reporting than has been obtained through traditional risk adjustment reporting. 

This increased focus on health improvement rather than disease identification has the potential to improve health outcomes rather than just identify them. For additional information on the CMS GPDC program or how it may improve beneficiary care and reduce risk adjustment scores, click here.

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