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Sutter Medicare Direct

Sutter Preferred Direct Contracting Entity, LLC, doing business as Sutter Medicare Direct, is participating in a new program with Centers for Medicare & Medicaid Services (CMS): Medicare Direct Contracting. The new program is specifically for patients with Original Medicare. It is designed to help providers work together to improve the health of patients by better coordinating care and focusing on prevention — while also reducing the total cost of care.

 

Sutter Medicare Direct
P.O. Box 161266
Sacramento, CA 95816
(833) 674-2323
SutterMedicareDirect@SutterHealth.org

For Patients

You may have received a letter that your doctor is part of Sutter Medicare Direct, a Medicare Direct Contracting Entity (DCE) participating in a new Medicare program.

 

Your Medicare benefits are not changing. You may continue seeing any doctor, hospital, or other healthcare provider of your choice that accepts Original Medicare.

Frequently Asked Questions

  • This is a special Medicare program for patients with Original Medicare that allows doctors to work together to keep patients healthy.

  • Patients with Original Medicare have a card that is red, white, and blue that says “Medicare Health Insurance” at the top. This includes those who are also covered by Medicare Supplement Insurance, also known as Medigap, secondary coverage offered by private health insurance companies.

  • Sutter Medicare Direct contracts with Medicare to participate in the Medicare Direct Contracting program. Sutter Medicare Direct is not an insurance company. It is part of the Sutter Health network, and it works with doctors and other providers who coordinate with one another to deliver high-quality care to patients.

  • No. Sutter Medicare Direct is not an HMO, a health plan, or an insurance company. It is part of Sutter Health and works with your doctors and care teams to better coordinate your care. You can continue to see any doctor, hospital, or other provider who accepts Original Medicare and you do not need any prior authorizations other than those already required by Original Medicare.

  • Your primary care doctor is now working with Sutter Medicare Direct. We are required to send a notice to patients with doctors who have decided to participate in this program.

  • No. The letter was sent to you for informational purposes only.

  • No. There are no changes to your coverage, benefits or doctors.

  • No. Your pharmacy benefits will remain the same.

  • Yes. Patients continue to have the freedom of choice to go to any doctor, hospital or other healthcare provider that accepts Original Medicare.

  • No. You will only need a prior authorization if Original Medicare requires one.

  • This new program allows Sutter team members to provide essential support services to your doctor, such as new tools, resources, or information—all with a focus on helping them coordinate and manage your care. For example, Sutter team members will contact patients following an unplanned hospital admission to help them schedule a primary care follow-up visit and help facilitate a smooth transition from hospital to home and avoid preventable hospital readmissions in the future. We also have case managers who will partner with patients identified as being at high or rising risk of complications to help them develop personalized goals to address medical or other issues.

    Another important initiative underway is ensuring all patients get a Medicare Annual Wellness Visit with a personalized prevention plan. Annual Wellness Visits also help us gain a better understanding of each patients’ unique care needs and can even enable us to address issues that affect patients’ health beyond the traditional care setting, such as housing, food stability, transportation, or social isolation.

  • No. This program does not change the relationship between you and your doctor. There are no networks or prior authorizations unless Original Medicare requires one. Sutter Medicare Direct simply works behind the scenes to coordinate otherwise siloed care with a focus on making care more efficient, eliminating waste and unnecessary services, and encouraging prevention. Additionally, patients may also receive more benefits at no cost through the program’s Benefit Enhancements.

  • One of the most important ways the program will help patients is by providing certain Benefit Enhancements for services that are not typically covered by Original Medicare. Examples include:

    • Skilled nursing facility (SNF) care for patients who don’t need an extended hospital stay but are not yet ready to be discharged home. Under routine Medicare rules, patients must have an inpatient hospital stay of no fewer than three consecutive days to be eligible for coverage of SNF care—regardless of their need for post-acute care. However, SMD patients who meet certain criteria and need skilled nursing or rehab services may be admitted for SNF care without a three-day inpatient hospital stay
    • Home health services for patients with multiple chronic conditions who are not homebound
    • Extended coverage of telehealth services for patients at home beyond the current Public Health Emergency (most Medicare coverage for telehealth will end 151 days after Health and Human Services lifts the Public Health Emergency)
  • No. This will not change what you pay out-of-pocket, such as any monthly premiums for Medicare Part B (Medical Insurance) or Medicare Part D (Prescription Drug Coverage), or the coinsurance you pay for doctor’s visits.

  • You can opt out of or modify data sharing preferences by calling (800) MEDICARE. However, CMS will still engage in limited data sharing with Sutter Medicare Direct for quality improvement.

  • You can learn more about Sutter Medicare Direct or Medicare Direct Contracting by emailing SutterMedicareDirect@SutterHealth.org or by calling (833) 674-2323.

About Sutter Medicare Direct

Sutter Medicare Direct includes clinicians and other providers serving as Participant Providers or Preferred Providers in Medicare Direct Contracting.

*Note: Sutter Medicare Direct does not have any joint venture relationships with any of its Participant Providers or Preferred Providers.

Participant Providers

Primary care physicians and advanced practice clinicians who are partnering with Sutter Medicare Direct in 2022.

Download Participant Providers (PDF)

Preferred Providers

Skilled nursing facilities and home health agencies that are collaborating with Sutter Medicare Direct in 2022.

Download Preferred Providers (PDF)

Executive Team and Governance

The Sutter Medicare Direct Executive Team provides administrative and clinical oversight for the organization’s participation in Medicare Direct Contracting. The Executive Team is accountable to a Board of Directors that has ultimate authority for the oversight and strategic direction of Sutter Medicare Direct.

    • Executive Officer: Todd Smith, VP, Product Development & Management, Health Plan Partnerships & Products, Sutter Health
    • Chief Financial Officer: Susan Burchiel, Executive Director of Enterprise Finance, Sutter Health
    • Chief Medical Officer: Audrey Tio, M.D., MHA, Sutter Medicare Direct CMO and Accountable Care Medical Director, Gould Medical Group
    • Executive Sponsor: Phil Jackson, CEO, Health Plan Partnerships & Products, Sutter Health
    • Executive Sponsor: Chris Stanley, M.D., Chief Population Health Officer, Sutter Health
    • Compliance: Ayshea Burroughs, Compliance Officer, Sutter Health
    • Information Technology: Jes Cornelius, Chief Information Officer, Sutter Health
    • Legal: Hilary Isacson, Assistant General Counsel, Sutter Health
    • Network Contracting: Lisa Bynum, VP, Network Contracting, Health Plan Partnerships & Products, Sutter Health
    • Network Performance Co-Chair: Steve Mitnick, M.D., CMO, Sutter Medical Group of the Redwoods
    • Network Performance Co-Chair: David Seidenwurm, M.D., SPA Medical Director, Sutter Medical Foundation
    • Quality & Safety: William Isenberg, M.D., VP, Chief Quality & Safety Officer, Sutter Health
    • Strategy: Will Hahn, Director of Strategy & Business Development, Medicare Sustainability, Health Plan Partnerships & Products, Sutter Health
    • Kristen Azar, Scientific Medical Director, IAHE
    • Steven Blair, M.D., President & CEO, Sutter North Medical Group
    • Dave Cheney, CEO, Sutter Health Hospitals
    • Theresa Frei, President & CEO, Sutter Valley Medical Foundation
    • Romelia Garcia, CEO, Sutter Care at Home
    • Ash Gokli, M.D., VP, Chief Clinical Operations Integration Officer

    • Christine Griger, M.D., President, Sutter Medical Group
    • Sue Haddad, CFO, Sutter Valley Medical Foundation
    • David Herbert, M.D., President & CEO, Sutter Independent Physicians
    • William Isenberg, M.D., VP, Chief Quality & Safety Officer, Sutter Health (Board Chair)
    • Phil Jackson, CEO, Health Plan Partnership & Products, Sutter Health
    • Barbara Kivowitz, Medicare Beneficiary & Consumer Advocate
    • Gary McLeod, M.D., President, Sutter Medical Group of the Redwoods
    • Adam Paley, M.D., President, Mills-Peninsula Medical Group
    • Sam Santoro, M.D., President & CEO, Sutter East Bay Medical Group
    • Larry Shore, M.D., Medical Director for Managed Care, Sutter West Bay Medical Group
    • Chris Stanley, M.D., Chief Population Health Officer, Sutter Health
    • Anil Thogarucheeti, M.D., Medical Director for Primary Care and Hospitalist Department Chair, Gould Medical Group
    • Christine Thorburn, M.D., Medical Director, Palo Alto Foundation Medical Group
    • Lizz Vilardo, M.D., President & CEO, Sutter Bay Medical Foundation
    • Janet Wagner, CEO, Mills-Peninsula Division

Financials

Sutter Medicare Direct publicly reports the following DCE Shared Savings or Shared Losses information:

Shared Savings or Losses

The amount of any Shared Savings or Shared Losses for any Performance Year.

Sutter Medicare Direct is in its first year of operation and does not have any data to report.

Shared Savings Investments

The proportion of Shared Savings invested in infrastructure, redesigned care processes, and other resources necessary to improve outcomes and reduce Medicare costs for patients.

Sutter Medicare Direct is in its first year of operation and does not have any data to report.

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