Cigna amps up Direct Contracting participation after program revamp

Cigna amps up Direct Contracting participation after program revamp

A Cigna subsidiary is the latest company to bank on the recently rebranded Direct Contracting program, the company announced on Wednesday.

The insurer’s value-based care consultancy, CareAllies, is participating in the Centers for Medicare and Medicaid Services’ Global and Professional Direct Contracting model, a payment plan that allows private payers and providers to take on risk for traditional Medicare enrollees.

Regulators replaced GPDC last week with a more equity-focused and provider-led Accountable Care Organization program, after facing strong pushback from provider groups and progressive Democrats, who argued that the previous design favored private equity and Medicare Advantage companies.

The redesigned model, named ACO Realizing Equity, Access, and Community Health Model, will begin next year and will continue to be run by the Center for Medicare and Medicaid Innovation. Current GPDC participants can continue on in ACO REACH—as long as they agree to meet all the new model’s requirements by the start date. The new model will continue through 2026.

By participating in GPDC, CareAllies aims to expand its geographic footprint in Texas and Arizona. CareAllies was unable to respond by deadline to how many lives it planned to manage through the new model, how many Direct Contracting lives Cigna is responsible for and why the company was getting involved in the program now, particularly as growth in its Medicare Advantage program stalls.

Cigna is one of the country’s largest Medicare Advantage carriers, with 567,000 enrollees at the end of 2021. Despite increasing enrollment 8% year-over-year, Medicare Advantage membership dipped below the insurer’s expectations, with executives crediting competitors’ aggressive pricing for eating up its market share.

“Through this program, we will help providers manage their Medicare patients, so these patients can obtain better quality, more affordable care within the communities they live,” Rob Cetti, president of CareAllies, said in a news release. “At the end of the day, we want to simplify value-based care and empower providers to help as many patients as possible get the care they need, regardless of their circumstance. We’ve been proud of our ability to do that in the past and are looking forward to continuing to do so through this model.”

CareAllies said its participation in GPDC builds on its previous work in the CMS’ Shared Savings Program, the largest alternative payment model in Medicare that awards providers who save the federal government money by coordinating care for beneficiaries. CareAllies said it currently works with more than 60 provider groups to manage the care of nearly 500,000 patients.

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Marie Maynes
Marie Maynes is a Sports enthusiast and writes for the Sports section of ANH.