Direct Contracting

What is the Direct Contracting Program?

The Direct Contracting (DC) Program applies to Medicare Fee-For-Service (original Medicare) beneficiaries. The DC Program is sponsored by the Center for Medicare and Medicaid Innovation (CMMI) and structured to test an array of financial risk-sharing arrangements designed to reduce Medicare expenditures while preserving or enhancing the quality of care furnished to original Medicare Service beneficiaries.

The DC Program offers levers that allow you as the provider to better manage the care continuum of original Medicare beneficiaries and total wellbeing through enhanced care coordination, data availability, and engagement through various payment, financial, and operational mechanisms.
The DC Program leverages lessons learned from other Medicare Accountable Care Organization (ACO) initiatives, such as the Medicare Shared Savings Program (MSSP) and the Next Generation ACO (NGACO) Model, as well as innovative approaches from Medicare Advantage (MA) and private sector risk-sharing arrangements.
The DC Program is a five-year program beginning on January 1, 2022.

What is a Direct Contracting Entity (DCE)?

A DCE is the entity that holds the DC Program agreement with CMS and administers the DC Program on behalf of participating providers. Northeast Georgia Health Partners Network has partnered with Lumeris to help facilitate the DC Program through Lumeris’ affiliated DCE. Lumeris will also help administer and drive outcomes within the DC Program. Lumeris has extensive experience and proven outcomes with risk/outcomes-based contracts and deep collaborative relationships that will be leveraged to serve the DC population.