• 02/25/2022

DCE: Direct Contracting Entities

Recent risk-sharing payment model in Medicare, launched by CMS, to promote value-based and coordinated care.

It differs from ACOs in terms of the requirements and level of risk available (refer to Table 1). Also, CMS would offer monthly Total Care Capitation or Primary Care Capitation (capitated and risk-adjusted) under two models – Professional and Global.

Interoperability is imperative for a DCE to succeed, Why?

  • A DCE should be able extract a cohort of patient records or access to patient-level data across a patient population
  • Integration of an internal clinical system with an EHR
  • Aggregating data from network of physicians/providers
  • Combining claims and electronic health record data to calculate quality measures
  • Building datasets to develop and tune machine-learning algorithms
  • Federated data sharing networks
  • Reporting performance metrics to CMS
  • Transmission of Claim and Claim Line Feed Reports (CCLF) from CMS
  • Alerting the DCE in real-time when their patient is admitted or discharged from an acute or post-acute care setting (monitoring of care path)
  • Inclusion of patients in their own care delivery

TIMELINE

Table 1

QHIN: Qualified Health Information network

Network of organizations working together to share data. QHINs will connect directly to each other to ensure interoperability between the networks they represent. By establishing a network of QHINs, TEFCA (Trusted Exchange Framework & Common Agreement) seeks to provide a single “on-ramp” for nationwide connectivity and ensure the integrity and security of data as it is delivered where and when needed.

Interoperability Play

  • Connectivity Broker is a service provided by a Qualified HIN that provides all of the following functions with respect to all Permitted Purposes: master patient index (federated or centralized); Record Locator Service; Broadcast and Directed Queries, and EHI return to an authorized requesting Qualified HIN.
  • A Participant is a person or entity that participates in the QHIN. Participants connect to each other through the QHIN, and they access organizations not included in their QHIN through QHIN-to-QHIN connectivity. Participants can be HINs, EHR vendors, and other types of organizations.
  • An End User is an individual or organization using the services of a Participant to send and/or receive electronic health info

Further Info on QHINs

Examples of QHINs

How will TEFCA work