Direct Contracting Entities * Generally, must have a minimum of 5,000 aligned Medicare FFS beneficiaries. * "On ramp" for organizations new to Medicare FFS. * Added flexibility for organizations serving dually eligible, chronically ill populations. High Need Populations DCEs focused on complex chronic and seriously ill populations will have some innovative approaches yet to be determined. Dually eligible beneficiaries will have access to a Program for Allinclusive Care of the Elderly (PACE) - like clinical approach with focus on an interdisciplinary team and minimum threshold allowances. There is also opportunity for collaboration with Medicaid Managed Care Organizations which will take accountability for Medicare costs and quality in addition to Medicaid spending under existing arrangements. Model Differences Differences Between Primary Care First Models and Direct Contracting Models * The PCF models are at the primary care provider group level with a minimum of 125 attributed beneficiaries per practice group in the PCF base model (not applicable to the High Needs Population/ Seriously Ill Population option). The DC models are at a population level, built off the Next Generation Accountable Care Organization (NGACO) model, with a minimum of 5,000 attributed beneficiaries for the Professional PBP and Global PBP. The Geographic PBP is yet to be determined but suggested attribution is around 75,000 Medicare beneficiaries. Before entering into a contract with a DCE, understand your program cost and your performance data. * Another big difference is the level of risk. The PCF models receive a per beneficiary per month rate and a flat rate for in-person encounters. They have additional ability to receive monetary rewards for achieving quality targets. The PCF risk is a 10% reduction if they fall at or below the target. In the DC PBPs the shared risk is greater. The Professional PBP is a 50% Savings/Losses risk arrangement. The Global PBP is a 100% Savings/Losses risk arrangement. The proposed Geographic PBP is a 100% Savings/Losses risk arrangement. * The PCF models are responsible for Medicare B only. Payments are adjusted to account for beneficiaries seeking services outside the practice. Depending on the payment option chosen, DCEs will be at risk for either a portion or all of the total cost of care for Medicare Parts A and B services for aligned beneficiaries. Newsline / Summer 2019 21