Direct Contracting and MSSP financial benchmark comparison

In November 2019, the Centers for Medicare and Medicaid Services (CMS) released the request for applications (RFA) for the Direct Contracting (DC) model’s Professional and Global options. The RFA contains a significant amount of important information for program participants. This new payment model gives participating provider organizations two options for risk-sharing arrangements as well as the opportunity to receive a prospectively determined, more predictable revenue stream. Applications for the first program year are due to the Center for Medicare and Medicaid Innovation by May 1, 2020.

The DC payment model options are conceptually similar to the other CMS accountable care organization (ACO) options, the Medicare Shared Savings Program (MSSP), and the Next Generation ACO model. Participants take on risk and earn potential rewards based on the efficiency and quality of care for aligned beneficiaries.

This paper by Milliman’s Matt Kramer, Erica Reijula, and Sam Shellabarger compares and contrasts the financial benchmark methodology between DC and MSSP.