CMS to Test Two Voluntary Risk-Sharing Options for Direct Contractors

CMS will test two voluntary risk-sharing options in Direct Contracting starting in 2021:

(1) Professional, a lower-risk option (50% Shared Savings/Shared Losses (SS/SL)) and Primary Care Capitation (PCC) equal to 7% of the total cost of care benchmark for enhanced primary care services; and

(2) Global, a full risk option (100% SS/SL) and either PCC or Total Care Capitation (TCC).  Additional information will be provided at a later date regarding a third option that CMS is considering offering, the Geographic option, which is a full risk option (100% SS/SL) for the total cost of care of all Medicare FFS beneficiaries in a defined target region.

The goals of Direct Contracting are to transform risk-sharing arrangements in Medicare FFS, broaden participation in CMS Innovation Center models, empower beneficiaries, and reduce health care clinician burden.  The Model options seek to align financial incentives, provide a prospectively determined and predictable revenue stream for participants, and put a greater emphasis on beneficiary choice.

For more information, read the fact sheet from CMS.

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