CMS Innovation Center Is Testing Direct Contracting Model
December 9, 2019The Center for Medicare and Medicaid Innovation is testing financial risk-sharing arrangements in two voluntary direct contracting options that will qualify as an advanced alternative payment model starting in the first performance year in 2021.
The first option is Professional, which is lower-risk, consisting of 50% shared savings/shared losses and primary care capitation equal to 7% of the total cost of care benchmark for enhanced primary care services.
The Professional option is testing a more gradual onramp to fully capitated payment under the second, Global option.
The Global option is one of full risk of 100% shared savings and shared losses in either primary care capitation or total care capitation, which encompasses all Medicare Part A and B services.
CMS is considering a third, Geographic option, which is a full risk for the total cost of care of all Medicare fee for service beneficiaries in a defined region.