Emerging Models: Direct Contracting

Direct Contracting (DC) is part of The Center for Medicare and Medicaid Innovation’s (CMMI) Primary Cares Initiative and was released in April 2019. It is one of the newest Medicare fee-for-service (FFS) risk sharing models built on lessons learned from the Medicare Shared Savings Program (MSSP) and Next Generation ACOs (NGACOs) and leverages innovative approaches from Medicare Advantage (MA) and private sector risk-sharing arrangements. The design is intended to broaden participation beyond current participants in Medicare FFS risk models by attracting traditional providers new to risk as well as other innovative partnerships/organizations looking to take risk for Medicare FFS beneficiaries.

This module consists of four components: 

Direct Contracting Brief: three pages, pdf

Highlights key components of CMS’ Direct Contracting Model options noting opportunities for SNFs

Direct Contracting Overview: six pages, pdf

Provides a detailed overview of Direct Contracting including types of participants, payment, beneficiary alignment, quality incentives, and a model timeline.

Geographic Direct Contracting Brief: Three pages, pdf

Presents key features of the Geographic Direct Contracting model that requires Geographic DCEs (Geo DCEs) to assume total cost of care risk for beneficiaries residing in defined geographic regions. Eligible beneficiaries are required to participate in the model if residing in designated regions.

Medicaid Managed Care Organization (MCO) - Based Direct Contracting: Two pages, pdf

Provides an overview of the Direct Contracting track designed for Medicaid Managed Care Organizations (MCOs) to serve enrollees who are dually eligible for Medicare and Medicaid including potential implications for SNF and AL providers.

Direct Contracting 101: Opportunity for SNF/PAC to Lead Webinar : 60 mins

Direct Contracting is one of the newest, voluntary Medicare fee-for-service (FFS) risk sharing models aimed at transforming care delivery and moving providers from volume to value. Direct Contracting is based on lessons learned from ACOs and features of Medicare Advantage and encourages participation by organizations serving  dually eligible and complex needs populations. It provides a potential path for innovative SNF/PAC providers to lead in managing risk.  Join this webinar to learn more about Direct Contracting -- key features, participation options, beneficiary criteria, payment and quality, model waivers, and opportunity for SNF/PAC.

 Direct Contracting 201 “Office Hours” Webinar: 60 mins

This session succeeds the Direct Contracting 101 webinar and offers attendees a brief overview of Direct Contracting including the recently released MCO-based DCE model and a comparison of Institutional Special Needs Plans (I-SNPs) and Direct Contracting. The session is designed to give attendees a greater opportunity to ask questions and receive answers regarding some of the more detailed pieces of the model. 

Meet the Speakers:

Tyler Cromer, Principal, ATI Advisory

Nisha Hammel, Senior Director, Population Health Management, AHCA