What is the CMS Direct Contracting Program?

Direct Contracting is an advanced alternative payment opportunity that focuses on reinvesting dollars back into primary care.

What benefits can I gain from joining this program?

Financial

  • Primary care providers (physicians and advance practice providers) can earn at least 30% more revenue per visit on their aligned Medicare FFS beneficiaries.
  • Health care organizations can also gain additional revenue by receiving a PMPM fee for up to 5 years.
  • No delay in cash flow like MSSP or Next Gen.

Reporting

  • Can participate in a CMS Advanced Alternative Payment Model (AAPM) without having to take on risk.
  • Will receive the 5% AAPM MIPS bonus.
  • Could potentially be excluded from reporting MIPS.

Resource

  • Dedicated Quality Improvement Advisor(s) (QIA) to help drive improved quality, health and cost outcomes based on the initiatives and measures you would like to improve.

Technology

  • No mandatory quality measure selection or reporting requirements due to the use of the Clover Assistant tool

What is the Clover Assistant tool?

The Clover Assistant tool is a web-based application powered by clinical and claims data on Medicare beneficiaries. The Clover Assistant supports you by:

  • Dynamically surfacing up-to-date, patient-specific information, including care gaps, medications, and potential diagnoses.
  • Providing you with a comprehensive view, populated with data from anywhere aligned beneficiaries have received care.

Can I leave the Program if I do not like it??

Yes, participants just need to give written notice.

If you are interested in more information on the program:

Please view the below video on the Clover Assistant Tool.

Contact ILHITREC at info@ILHITREC.org or 815-753-5900 for more information.

If you are interested in participating in this program:

Please complete the Letter of Participation and email it to info@ILHITREC.org, and someone from ILHITREC will contact you.