Direct Contracting is a new model from the Center for Medicare & Medicaid Innovation (CMMI, or the CMS Innovation Center) aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). At a minimum, it’s an opportunity for providers to change the way they care for Medicare FFS patients. And if the Geographic Direct Contracting Model is launched (it’s currently under review by CMS), it will be a sea change in the 10 targeted “Geo” regions. Either way, it’s worth paying attention to.

We covered the Direct Contracting model and options at length in Episode 156 with Gail Zahtz. You should start there if Direct Contracting is new to you. During that conversation, Zahtz identified plenty of areas where the model could benefit doctors and their patients. However, she identified several grey areas that make it difficult for physicians to engage with potential DCEs as the application deadline rapidly approaches (April 1, 2021).

The timeline and lack of clarity make it difficult for a physician to evaluate the model and make a sound decision on how, or if to participate.

So, that’s our goal of this discussion.  I talk with Dr. Krishnan Narasimhan, an academic family medicine physician and an Associate Professor in the Department of Community and Family Medicine at Howard University, about what Direct Contracting means to physicians.

  • What opportunities does Direct Contracting create for physicians?
  • What opportunities does Direct Contracting create for their patients?
  • How does Direct Contracting compare to other value-based payment programs?
  • How might Direct Contracting lead to deeper physician-payer alignment?
  • How does Direct Contracting enable physicians to truly address the Social Determinants of Health (SDOH)?
  • What questions should a physician ask a DCE to determine if they are a fit?
  • What should physicians’ do right now to determine if Direct Contracting is worth pursuing?
  • How can busy physicians fit this in with all their existing priorities during a pandemic?

Dr. Krishnan Narasimhan

Krishnan Narasimhan M.D., is an academic family physician who has a proven record of driving health system and policy change.

Dr. Narasimhan has led grassroots coalitions to move the political and policy debate on health reform, expand access, and to increase primary care infrastructure. He has spoken at the U.S. Capitol, at universities, and with numerous stakeholders on health reform, health disparities, and physician workforce. He serves on the Boards of Doctors for America and the District of Columbia Academy of Family Physicians.

Dr. Narasimhan has a decade of experience in undergraduate and graduate medical education with a focus on curricular design, mentorship, and integrated care models. He has a record of consistently increasing primary care workforce capacity. His research on the Economic Impact of Family Physicians has been utilized extensively by the American Academy of Family Physicians.

Currently he serves as Associate Professor at Howard University, Director of the Family Medicine Clerkship, as Residency faculty, and takes care of underserved populations.

His training includes an M.D. from Jefferson Medical College, residency at University of Connecticut, Primary Care Health Policy Fellowship at Georgetown University, and a Certificate of Health Policy at the Georgetown Public Policy Institute.

Dr. Narasimhan is also an advisor to WiseCare, a startup applying to become a Direct Contracting Entity (DCE). 

LinkedIn: https://www.linkedin.com/in/krishnanmd/

Links and Resources


Listen to the full discussion with Dr. Krishnan Narasimhan right here:

Or, find it on your favorite podcast network such as:


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