SACRAMENTO, Calif., —Today, not-for-profit integrated healthcare system Sutter Health announced its participation in Medicare Direct Contracting. This innovative, value-based payment model with the Centers for Medicare & Medicaid Services (CMS) is designed to enhance quality and reduce the total cost of care specifically for people with Original Medicare.
Sutter joined the program on Jan. 1, 2022, through its Direct Contracting Entity (DCE), Sutter Preferred Direct Contracting Entity, LLC, doing business as Sutter Medicare Direct. Sutter Medicare Direct includes nearly 1,200 clinicians serving as Participant Providers in the program. It is their Original Medicare patients are attributed to and served by the DCE—approximately 121,000 Northern Californians. In this new payment model, Sutter is accountable for the overall quality and cost of medical care delivered to these aligned patients.
Advancing Quality and Affordability for Patients
In the communities it serves, the Sutter Health network cares for more than a quarter of all people with Medicare. Most of its Medicare patients, including those who age-in to Medicare each year, choose Original Medicare, which is a fee-for-service transaction-based payment model that pays clinicians on a per-unit basis for the amount of healthcare services they deliver. Yet, data points to patients in value-based payment models, including Medicare Advantage, experiencing better overall healthcare outcomes.
“Joining Medicare Direct Contracting opens new doors to improving care for all of our patients with Original Medicare,” says Todd Smith, executive officer of Sutter Medicare Direct. “Value-based payment models are designed to promote care coordination and prevention resulting in better outcomes, lower costs and more favorable experiences when compared to fee-for-service models. We expect the results in Medicare Direct Contracting to be the same.”
Focusing on Population Health, Outcomes
Sutter Medicare Direct will provide clinicians with population health management support, using data and analytics to identify patients at high or rising risk for complications. A care management team comprised of healthcare professionals from various disciplines within Sutter Population Health Services will use the data to provide performance reports and help clinicians proactively manage patients. Patients will also see certain benefit enhancements to access services that are not typically covered by Original Medicare, such as telehealth services like video visits and phone consults, and improved access to homecare and skilled nursing care.
“What’s different about this program is the focus on taking care of our patients in a population health model—an exciting proposition which uses data and care managers to better support our clinicians in delivering the right care for our patients at the right place and right time,” says Dr. Chris Stanley, chief population health officer at Sutter Health who also serves on the Sutter Medicare Direct Board of Directors. “We also appreciate the opportunity to support patients in a more holistic way that goes beyond traditional clinical treatment.”
The new program allows Sutter to look for ways to help address some social determinants of health—factors in a patient’s life that often have a greater impact on their health and well-being than care traditionally delivered in the healthcare setting. Through its clinical and analytical capabilities, Sutter Medicare Direct will work with team members from across the Sutter network to develop programs and services to help at-risk patients.
Summing up the potential benefits of the program for both the organization and patients, Smith continues, “Sutter Medicare Direct provides the unique opportunity for our integrated healthcare system to advance the way we care for more than 121,000 Original Medicare patients, while also reducing the total cost of delivering this care. It has the potential to be one of our most impactful strategies yet to improve the health of the patients we are privileged to serve.”
Disclaimer: 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.