Direct Contracting Model

DPC@cms.hhs.gov

Building on lessons learned from initiatives involving Medicare Accountable Care Organizations, the Direct Contracting Model is a set of 3 voluntary payment model options designed to reduce expenditures and preserve and enhance quality of care for Medicare fee-for-service (FFS) beneficiaries.

This model provides new opportunities for a variety of different organizations to participate in value-based care arrangements in Medicare FFS, including organizations without significant experience in FFS.

Direct Contracting seeks to improve quality of care and health outcomes for Medicare beneficiaries through alignment of financial incentives to promote effective and appropriate care, emphasis on patient choice, strong monitoring to ensure that beneficiaries maintain access to care, and emphasis on care delivery for the complex, chronically and seriously ill population.

Specific information on model options is available in the Request for applications.

Eligible participants are legal entities that contract with Direct Contract Participant Providers, including, but not limited to:

• Physicians and other practitioners in group practice arrangements
• Networks of individual practices of physicians and other practitioners
• Hospitals employing physicians and other practitioners
• Federally Qualified Health Centers (FQHCs)
• Rural Health Clinics (RHCs)
• Critical Access Hospitals (CAHs)

Payment options will be provided to 3 types of Direct Contracting Entities (DCEs) with different characteristics and operational parameters.

• Standard DCEs - Organizations that have experience serving Medicare FFS beneficiaries
• New Entrant DCEs - Organizations that have not traditionally provided services to a Medicare FFS population
• High Needs Population DCEs - Organizations that serve Medicare FFS beneficiaries with complex needs

The model will be tested over 6 years.

Links to additional guidance are available on the program website.