Medicare Value-Based Contracting Model Emphasizes Care Coordination

The Geographic Direct Contracting Model uses outcomes-based payment models to address care quality, healthcare spending, care coordination, clinical management, and program integrity in targeted regions.

The geographic direct contracting model allows direct contracting entities—which are payer or provider organizations engaged in certain alternative payment models with CMS—to better integrate care while taking full risk with 100 percent shared savings and shared losses for Medicare Part A and Part B. Direct contracting has been the basis for models in the past, including some chronic kidney disease models and the Direct Contracting Global and Professional Options.

For preferred providers, direct contracting entities may use strategies including prior authorization, concurrent or pre-claim review, or pre-payment claim edits to check integrity. For non-preferred providers, direct contracting entities may use these tools as well, except for prior authorization.