Skylight Health Partners with Major National Direct Contracting Entity for Value-Based Care Participation
TORONTO, ON – October 7, 2021 – Skylight Health Group Inc. (NASDAQ: SLHG; TSXV:SLHG) (“Skylight Health”, “Skylight” or the “Company”), a multi-state primary care group in the United States, today announced the execution of a Participation Provider Contract with a leading national healthcare organization who is a recipient of a Direct Contracting Entity (“DCE”) license, with Skylight Health’s participation beginning in 2022. The Agreement to join the DCE is a major upgrade from the previously announced Accountable Care Organization (ACO) and is expected to result in improved care and benefits for traditional Medicare patients.
- The DCE contracts directly with the Centers for Medicare & Medicaid Services (“CMS”) and provides multiple enhanced pathways for risk-sharing arrangements;
- Skylight will begin participation in January 2022 and expects to move from a single-sided risk arrangement with a goal of shifting to full risk;
- Skylight will receive the additional benefit of capitation in addition to the Fee-for-Service and shared savings the Company would have received via the previously announced ACO; and
- In addition to Skylight’s current traditional Medicare patients, those qualifying patients that Skylight acquires through acquisition and de novo growth will be eligible for participation in the DCE.
The Direct Contracting Model (the “Model”) was designed by the CMS Innovation Center (CMMI) as the next evolution in risk sharing arrangements to produce value and high-quality healthcare. The Model is a set of two voluntary risk-sharing options aimed at reducing expenditures and preserving or enhancing quality of care for Medicare FFS beneficiaries. Provider groups in the Model assume higher levels of financial risk and expected improved financial reward than are available under the MSSP.
The DCE entity that Skylight will be partnering with brings several years of value-based care programs managing over 200,000 value based patient lives annually. By partnering with a National entity, Skylight can expect to receive infrastructure and capability support to accelerate its shift to risk. The name of the DCE entity will remain confidential as per the terms of its agreement with CMS prior to the participation year.
“This is a significant move forward for all of us here at Skylight,” said Prad Sekar, CEO at Skylight. “Our ACO has enabled us to chart a path forward where we will now see ourselves working in the latest CMS initiative for value-based care with a strong partner with decades of experience in various value models. Through the DCE, our patients will benefit from improved services and quality of care. With the infrastructure that our partner brings, we can also leverage the robust resources of a Fortune 50 National healthcare enterprise. We will continue to maintain our ACO as we look forward to future commercial contracts.”