![]() This proposal, The Commonwealth Fund report said, is “one of the most significant changes to the way Medicare beneficiaries receive health care since managed care was introduced into Medicare in the 1970s,” adding the model was “raising critical questions particularly among beneficiary groups.” Perhaps due to the wonky nature of the discussion, the proposed change has generated almost no media coverage although it would upend the health insurance for millions of Americans. That would be the first time in the history of the program that beneficiaries would be forced into any kind of new care arrangement. It would work sort of like Medicare managed care does now, but unlike people in Medicare managed care who have chosen to be in that program, beneficiaries who live in one of those selected regions would be required to choose one of these new entities in order to receive any Medicare benefits at all. The goal is to boost quality and lower costs. The Fund* explained that the Center for Medicare & Medicaid Services (CMS) had just unveiled the Geographic Contracting model, or “Geo,” a wonky proposal meaning that beneficiaries in traditional Medicare in 10 metro regions across the country, “will be required to enroll” in what’s being called a “direct contracting entity.” That entity, which could be a physician group, insurance company, managed care organization, or accountable care organization, would deliver all the care for those in the plan and receive one payment from the government for giving that care. ![]() Right before Christmas The Commonwealth Fund in New York City issued a worrisome report aimed particularly at the 38 million beneficiaries who are in the so-called traditional Medicare fee-for-service program, not the heavily advertised Medicare Advantage managed care plans.
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