In late April 2019, the CMS Center for Medicare and Medicaid Innovation (CMMI) announced its long-awaited Direct Contracting payment models, which encourage primary care providers to take on two-sided risk. While some details of the program remain unclear, Evolent Health offered the center input on these models, including a set of principles that we believe should guide the program.
These principles include:
- Incentivize and give primacy to full-risk, total-cost-of-care models.
- Ensure sufficient flexibility within the payment rate to support administrative costs and creative payment incentive arrangements between Direct Contracting Entities and their participating and preferred providers.
- Provide strong tools and incentives for providers and beneficiaries to form high-value Direct Contracting networks.
- Provide a sustainable benchmarking methodology that considers organizations’ prior experience in risk and incentivizes both value and efficiency.
- Provide a stable and consistent risk adjustment methodology.
- Ensure predictability and stability for organizations assuming significant risk.
For details, read the full letter to Adam Boehler, CMS Deputy Administrator for Innovation & Quality and CMMI Director.
Learn More About Direct Contracting
Find additional insights in these Evolent Knowledge Center resources.
