The Centers for Medicare & Medicaid Services (CMS) have launched a variety of Alternative Payment Models (APMs) intending to incentivize providers to maintain or improve quality outcomes for traditional Medicare fee-for-service (FFS) beneficiaries, while also reducing their healthcare costs. The latest model is the CMS Direct Contracting Entity (DCE) model, which mirrors these goals and leverages lessons picked up from previous APM models to expand participation to a broader range of medical groups, physician groups, health systems, and risk-bearing organizations.

CMS designed the Direct Contracting model options to accommodate the variety of provider organizations that may apply. Each DCE model type has unique features that are intended to attract a broader range of participants, such as different risk models, beneficiary alignment requirements, and payment mechanisms. In CMS’ consideration of qualified applicants, applicants must demonstrate an organizational structure that promotes the goals of the models. It will include a diverse set of providers and suppliers who can exhibit a commitment to high-quality care. CMS will assess applications according to the specific criteria in five key domains:

• organizational structure
• leadership and management
• financial plan and risk-sharing experience
• patient-centeredness and beneficiary engagement
• clinical care

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