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Population Health

Direct Contracting: Frequently Asked Questions

This FAQ provides Medicare beneficiaries with answers to some of the most frequently asked questions about CMS direct contracting.

If you have any additional questions, feel free to ask your doctor or other healthcare professional, call the Temple Center for Population Health at 215-926-3500, or call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about DCEs.

What is Direct Contracting?

Medicare has started an initiative where health care providers who share a common set of goals aimed at improving patient care can work together more effectively. This initiative brings together health care professionals in a Direct Contracting Entity (DCE), to work together with Medicare to give you more coordinated care and services.

Who is the Temple Center for Population Health?

The Temple Center for Population Health is part of the Temple Health System. They provide nurses, community health and social workers to work with beneficiaries and their physicians to help achieving better health.

How will this program benefit beneficiaries?

The Temple Center for Population Health Direct Contracting program will benefit beneficiaries in several ways that include:

  • Additional support through care management with nurses, CHW’s and social workers.
  • Beneficiary incentives upon completion of a care management program.
  • Additional flexibilities, including home visits to prevent hospital admissions.
Why do beneficiaries need to let Medicare know who is their primary care physician? Shouldn’t Medicare already know this detail?

Medicare has created a process where the beneficiary can select their primary care provider, so they can participate in the services offered by the Temple Center for Population Health. When a beneficiary chooses a primary practitioner, it allows the DCE to gain better insight into the beneficiary’s health and conditions via additional information contained in risk scores and practice feedback reports. This can lead to improved patient-centered care for the beneficiary.

Is this program only at Temple Health? What if the patient sees a specialist or another community provider outside of the Temple Center for Population Health? Is this ok?

Selecting your primary care physician allows the beneficiary to choose who will be primarily responsible for their care in this program and be eligible for the benefits/services in this program. Going to a specialist or another community provider outside of TCPH will not be affected by participating in this program.

What happens if a beneficiary does not select a primary care provider?

Medicare beneficiaries will continue to receive their normal benefits that Medicare provides, and beneficiaries can see their usual physicians. Medicare may assign a beneficiary to the program, based on the frequency that they see their primary doctor.

Are beneficiaries with a Medicare supplemental plan eligible?

Beneficiaries must be Medicare Primary A and B. They may also have a supplemental policy.

What is the duration of the Temple Health Direct Contracting program?

This is a five-year program starting in January 2022 and running through December 2026.

What happens if the beneficiary switches plans after the sign up, which Medicare Plans does this pertain to? What do we have to do, do we have to unlink them?

If the beneficiary enrolls in a different plan that is not Medicare FFS (A or B) then they would no longer be included in the program or included in the attribution list. This happens frequently with Medicare Advantage. No action would be necessary on the Temple Health side to update. The change in patient status would be updated by Medicare.

What if a provider leaves, does the patient have to re-elect?

The program (and voluntary alignment) will remain with the Temple Health Direct Contracting. After two years, CMS will look to see if visits have occurred with the DCE to decide on alignment beyond this timeframe.

Where can I find my MBI number?

The Medicare Beneficiary Identifier (MBI) is the new identification number that has replaced the SSN-based health insurance claim numbers (HUCBs) on all Medicare transactions, such as billing, claim submissions and appeals. On your Medicare card, you will notice that your MBI "number" is actually alphanumeric or having both upper-case letters and numbers (from the sample graphic below you can see the MBI: "1EG4-TE5-MK72”.