Direct Contracting

The Direct Contracting Model builds upon the successful Next Generation ACO Model and offers higher levels of risk and reward than the Medicare Shared Savings Program. There are at least two options, Professional and Global, each with three types of Direct Contracting Entities; Standard, New Entrant and High Needs Populations. The six-year model launched with an implementation period in October 2020 and its first performance year on April 1, 2021.

Questions or feedback about the model are welcomed and can be sent to [email protected]. 


  • CMMI’s Direct Contracting webpage

CMS Resources

  • Current and Past Participation Agreements 

  • Guidance on Contractual Agreements with Downstream Providers 

  • Financial Guarantee Guidance for Direct Contracting Entities 

  • CMS guidance on Benefit Enhancements and Beneficiary Engagement Incentives 

  • CMS FAQs on Direct Contracting from October 2020

    • Voluntary Alignment FAQs

    • Benefit Enhancements FAQs
  • CMS FAQs on participation management 

  • Welcome Packet for Direct Contracting Implementation Period Participants 
  • Detailed information on the model’s financial methodology can be found on CMMI’s page

NAACOS Member Resources 

News and Advocacy

  • Hundreds of healthcare organizations join NAACOS on a letter to HHS Sec. Becerra urging him to fix, don’t end, Direct Contracting

  • NAACOS writes CMS in support of provider-led DCEs, amid scrutiny

  • NAACOS Statement on CMS Innovation Center Strategy

  • NAACOS letter to Innovation Center makes recommendations on improving Direct Contracting

  • NAACOS letter to the Innovation Center outlines steps to promote value-based care and provides detailed program recommendations

  • NAACOS writes HHS Secretary Becerra on policy priorities for the new administration

  • NAACOS letter calls for changes to Direct Contracting's financial methodology, stopping Geographic option

  • NAACOS Welcomes the First Direct Contracting Entities

  • NAACOS statement on CMMI’s clarity on Direct Contracting’s future

  • NAACOS urges swift action to extend the Next Generation ACO Model and announce plans for the future of the Direct Contracting Model

  • NAACOS calls for changes to Direct Contracting and seeks more information

  • NAACOS Launches Direct Contracting Taskforce

  • NAACOS Statement on Direct Contracting Request for Applications

  • NAACOS submits feedback on new Geographic and Professional and Global Options of Direct Contracting Models from the CMS Innovation Center

  • NAACOS released a statement welcoming more options for value-based payment arrangements in the form of Direct Contracting and Primary Care First

  • NAACOS calls for greater transparency in Innovation Center’s work

  • NAACOS submits comments in response to CMS’s Request for Information on Direct Provider Contracting models

 indicates members only resource