On April 22, 2019, the CMS Center for Medicare and Medicaid Innovation (CMMI) announced its much-anticipated Direct Contracting payment model, giving primary care providers and other organizations the opportunity to take increased financial risk for a population of patients. Designed for larger, more sophisticated organizations that care for at least 5,000 Medicare beneficiaries, the program will provide capitated, risk-adjusted monthly payments to providers, who can take up to 100% risk.
Evolent Health experts, who provided input to CMMI on these new models, developed this fact sheet to provide an overview of the program and address common questions surrounding:
- Model options (risk structure and cash flow)
- Eligible participants and beneficiary target populations, benefit enhancements and waivers
- Program application timelines
- Unresolved questions about the program
For more insights on what the Direct Contracting model means to providers, read the April 23 blog post by Evolent Vice President of Health Policy Ashley Ridlon.