CMS launched Medicare Direct Contracting (MDC) in 2019 also known as a Direct Contracting Entity (DCE), the Direct Contracting Model creates an opportunity for the Centers for Medicare & Medicaid Services to preserve or enhance the quality of care to beneficiaries that should reduce Medicare expenditures. The program builds on existing features of accountable care organization (ACO) models and initiatives including lessons learned to enhance the new DCE model. This model is part of a strategy by the CMS Innovation Center to use the redesign of primary care and ACO’s as a platform to drive broader health care delivery system reform. On signing the agreement to participate in the program, the DCE must meet criteria outlined by the Center for Medicare and Medicaid Innovation (CMMI) in the request for applications. The model creates a variety of pathways for participants to take on financial risk supported by enhanced benefits such as Skilled Nursing Facility 3-Day Waiver and Home Health. The aim is to attract a diverse team of entities, including physician organizations and existing health entities such as Next Generation ACOs, Shared Savings Program ACOs and Managed Care Organizations (MCOs) with fully integrated and dual plans. This model focuses on primary care, chronic care and complicated conditions afflicting patients, minimizing administrative workloads while maintaining timely patient access to care.