Global and Professional Direct Contracting (GPDC) Model

Update: The Global and Professional Direct Contracting Model (GPDC) Model has been redesigned and renamed The ACO Realizing Equity, Access and Community Health (ACO REACH) Model.  Please note that any information on this page referencing the GPDC Model beyond December 31, 2022 is outdated. For more information on the ACO REACH Model, please see the ACO REACH Model webpage.

In addition, CMS is permanently cancelling the Geographic Direct Contracting (Geo) Model, which has been on hold since March 2021. The Geo Model is being canceled because it does not align with CMS’ vision for accountable care and concerns raised by stakeholders.

Background

The Centers for Medicare & Medicaid Services (CMS) has redesigned the Global and Professional Direct Contracting Model (GPDC) Model in response to Administration priorities, including our commitment to advancing health equity, stakeholder feedback, and participant experience. We are renaming the model the ACO REACH Model to better align the name with the purpose of the model: to improve the quality of care for people with Medicare through better care coordination, reaching and connecting health care providers and beneficiaries, including those beneficiaries who are underserved, a priority of the Biden-Harris Administration. CMS released a Request for Applications (RFA) to solicit a new cohort of participants for the ACO REACH Model to begin participation on January 1, 2023.

The Global and Professional Direct Contracting (GPDC) Model was a voluntary, Accountable Care Organization (ACO) model designed to put patients at the center of their care. Building upon lessons-learned from initiatives involving Medicare ACOs, such as the Medicare Shared Savings Program and the Next Generation ACO Model, this model provided greater individualized attention to a beneficiary’s specific health care needs within Original Medicare, and changed financial incentives to reward high quality care.

The GPDC Model aimed to improve beneficiaries’ experience of care. Beneficiaries were aligned to an entity participating in the model if they chose a primary care doctor who was part of a Direct Contracting Entity (DCE – another word for ACO) participating in the model. Beneficiaries maintained the right to opt out of model-related aspects of care and could elect to see any provider they chose without being restricted to a network. Beneficiaries aligned to DCEs participating in the GPDC Model could have benefited from aspects of the model such as increased access to telehealth and in-home skilled care for beneficiaries who are not otherwise eligible for home health services. All beneficiaries aligned to a DCE in the GPDC model remained in Original Medicare and retained all of their rights and privileges, including the freedom to see any Medicare provider.

The GPDC Model benefited participating organizations by reducing practices’ administrative burden, allowing health care providers greater flexibility in how they deliver care, and rewarding them for improving quality. By tying payments to improvements in the quality of care provided, health care providers were incentivized to collaborate across multiple treatment plans, spend more time with patients with complex, chronic conditions and ultimately, improve patient health outcomes.

GPDC Model Goals (PNG)

The Model's goals were to:

  • Transform risk-sharing arrangements in Original Medicare by tying payment to the quality of care provided to patients and reducing total expenditures through partially capitated payments that move away from traditional fee-for-service.
     
  • Empower beneficiaries to engage in their health care with support from DCEs that help them to navigate the complex health care system. The model offered many additional flexibilities for beneficiaries, such as making in-home care management visits available when a patient is at high risk for hospitalization.
     
  • Reduce provider administrative burden so that they could focus on what is most important: spending time with patients. For example, participants were able to report quality measures that focused more on outcomes and beneficiary experience in lieu of measures that focus on process. As a result, the providers could spend more time focused on the specific and individualized needs of their patients.

Model Details

The GPDC Model was designed to provide new opportunities for a variety of different health care organizations and physician practices to participate in value-based care arrangements in Original Medicare. Under the model, there were three types of participants with different characteristics and operational parameters:

  1. Standard DCEs - DCEs comprised of organizations that generally have experience serving Original Medicare patients, including Medicare-only and also dually eligible beneficiaries, who were aligned to a DCE through voluntary alignment or claims-based alignment. These organizations may have previously participated in another CMS Innovation Center shared savings model (e.g., Next Generation ACO Model and Pioneer ACO Model) and/or the Shared Savings Program. Alternatively, new organizations, composed of existing Original Medicare providers and suppliers, were created to form a Standard DCE. In either case, clinicians participating within these organizations would have substantial experience serving Original Medicare beneficiaries.
  2. New Entrant DCEs - DCEs comprised of organizations that have not traditionally provided services to an Original Medicare population and who may rely primarily on voluntary alignment, at least in the first few performance years of the model. Claims-based alignment was also utilized. 
  3. High Needs Population DCEs – DCEs that serve Original Medicare patients with complex needs, including dually eligible beneficiaries, who are aligned to the DCE through voluntary alignment or claims-based alignment.
    1. These participants were expected to use a model of care designed to serve individuals with complex needs, such as the one employed by the Programs of All-Inclusive Care for the Elderly (PACE), to coordinate care for their aligned beneficiaries.

Participant Options

There were two voluntary risk-sharing options under the GPDC Model. In each option, participating providers accepted Medicare claims reductions and agree to receive at least some compensation from their DCE.

  1. Professional. A lower risk-sharing arrangement—50% savings/losses—with one payment option for participants: Primary Care Capitation Payment, a risk-adjusted monthly payment for primary care services provided by the DCE’s participating providers.
  2. Global. A higher risk sharing arrangement—100% savings/losses—with two payment options: Primary Care Capitation Payment (described above) or Total Care Capitation Payment, a risk-adjusted monthly payment for all covered services, including specialty care, provided by the DCE’s participating providers.

Information for Active DCEs

CMS has determined that, beginning April 1, 2021, the anti-kickback statute safe harbor for CMS-sponsored model arrangements (42 CFR § 1001.952(ii)(1)) is available to protect certain DCE financial arrangements between or among the DCE, one or more DC Participant Providers, one or more Preferred Providers, or a combination thereof, provided that such arrangements comply with the requirements set forth in Section 3.04.M.1 of the GPDC Model Performance Period Participation Agreement (“Participation Agreement”). (Unless otherwise specified, capitalized terms have the meaning set forth in the Participation Agreement.)

Further, CMS has determined that, beginning April 1, 2021, the anti-kickback statute safe harbor for CMS-sponsored model patient incentives (42 CFR § 1001.952(ii)(2)) is available to protect certain in-kind patient incentives and Beneficiary Engagement Incentives furnished by a DCE, DC Participant Provider, or Preferred Provider to a Beneficiary or DC Beneficiary (as applicable), provided that such incentives are furnished in a manner that complies with the requirements set forth in Section 5.08.B of the Participation Agreement.

The GPDC Model was an Advanced Alternative Payment Model (APM) starting in its first performance year (PY2021).

Transparency and Data Sharing

CMS recognized that stakeholders are interested in information about models, including greater insights into the participants, what they were doing to improve care, and impacts on quality and costs in advance of evaluation results being published. CMS is committed to providing greater transparency into the GPDC Model.

For the GPDC Model, CMS shared the following information, regarding each DCE participating in the model:

  • Type of entity (Standard, New Entrant, High Needs),
  • Risk-sharing arrangement (Global or Professional)
  • Payment option (Primary Care Capitation, Total Care Capitation, Advanced Payment),
  • Benefit enhancements and beneficiary engagement incentives they have selected to use (e.g., care management home visits to prevent hospitalization, waiver of the Medicare homebound requirement for access to home health services, Part B cost sharing support),
  • Organization website, and
  • Core service area.

CMS will also shared aggregate information for all DCEs on quality and financial performance based on operations data and financial benchmarks, not evaluation, which is updated quarterly. It is important to note that the quality information presented is for two claims-based measures—All Cause Readmissions and Unplanned Admissions for Multiple Chronic Conditions. In addition, information is shared on the payments being made to DCEs on a quarterly basis.

Refer to the GPDC Model Participant Overview and the Quarterly Summary of Quality Performance, Financial Performance, and Model Payments in the Additional Information section below for this information and data.

Information for Interested Stakeholders

NOTE: Any information referencing GPDC beyond December 31, 2022 is outdated. Please see the ACO REACH model page for information about the model’s future.

For any questions related to the GPDC Model, please email the ACO REACH Model team at ACOREACH@cms.hhs.gov.

Additional Information

Evaluation Reports

Prior Evaluation Reports

Financial and Quality Results

Financial Methodology

Webinars

Where Health Care Innovation is Happening