An ACO REACH creates a new opportunity for the Centers for Medicare & Medicaid Services. To test an array of financial risk-sharing arrangements expected to reduce Medicare expenditures while preserving or enhancing the quality of care to beneficiaries. The Direct Contracting Model leverages lessons learned from other Medicare Accountable Care Organization (ACO) initiatives. This model is part of a strategy by the CMS Innovation Center to use the redesign of primary care as a platform to drive broader health care delivery system reform. The model creates a variety of pathways for participants to take on financial risk supported by enhanced flexibilities. The model reduces burden, supports a focus on complex, chronically and seriously ill patients, and aims to encourage organizations to participate that have not typically participated in Medicare fee-for-service (FFS) models. We anticipate that this model will appeal to a board range of physician organizations and other types of health organizations.