CMS unveils person-centered primary care model but excludes high-revenue ACOs

The Centers for Medicare & Medicaid Services (CMS) has announced the ACO Primary Care Flex Model (ACO PC Flex Model), allowing eligible accountable care organizations to treat people with with Medicare using person-centered proactive care.

The model will give a one-time advanced shared savings payment and monthly prospective primary care payments to ACOs. In theory, it will provide needed flexibility and resources to ACOs required to form an ACO and administrative costs necessary to function.

It will be tested within the Medicare Shared Savings Program (MSSP) by the CMS Innovation Center, however, it only applies to low revenue ACOs. CMS said this is because low revenue ACOs typically perform better in MSSP.

“We continue our work to improve the quality of care for people with Medicare by encouraging more primary care providers to participate in the ACO Primary Care Flex Model,” said HHS Secretary Xavier Becerra in a statement. “Incentivizing greater investments in primary care will promote competition among health care providers and enable more people to receive coordinated, high-quality preventive care to keep them healthy – regardless of where they live."

Designed to enhance primary care funding, the model should create total cost of care savings and address health disparities, according to a news release. Prospective primary care payments will be calculated from county-average spending.

CMS Innovation Center Director Liz Fowler said during a webinar following the announcement that Medicare beneficiaries in this model are more likely to receive preventive health services and screenings that improves chronic care management. She said the model includes recommendations from the National Academies of Sciences, Engineering and Medicine. Fowler also believes clinicians will be more incentivized to form ACOs due to the implementation of this model.

Health equity, she noted, is another priority of the ACO PC Flex model.

"Growing participation by safety net providers is really a key factor in improving access to care for underserved populations, including those in rural areas and historically disadvantaged communities," said Fowler. "ACO PC Flex includes special considerations for rural health clinics and federally qualified health centers (FQHCs) who are fee-for-service like other primary care providers."

FQHCs will only benefit from higher levels of primary care investments, said Ben Money, the senior vice president of public health priorities for the National Association of Community Health Centers. He said moving to value-based care is "essential" and the model is a "step in the right direction" because of the payment methodology and stable revenue for providers to switch to value-based care.

"I think this really differs from fee-for-service models that often reinforces patterns of under utilization among systemically underserved communities," explained Sarah Coombs, director for health system transformation at the National Partnership for Women & Families. She noted Medicare beneficiaries could have greater access to telehealth and newfound access to multidisciplinary care teams.

The model is a five years and voluntary. It will begin on Jan. 1, 2025, and the agency will select around 130 ACOs.

Industry organizations were largely appreciative of the news.

"Shifting to prospective payments provides primary care practices with stable and predictable cash flow needed to transform care delivery and provide comprehensive, team-based care," said NAACOS in a statement. "This model builds on the success of MSSP while recognizing we must continue to evolve the program in order to grow the program.

"While we are extremely pleased with the model, we ask that CMS reconsider excluding high-revenue ACOs, which prevents independent primary care practices who have partnered with their local health systems from taking advantage of these much needed innovations," the group added. "The premise of ACOs is to bring together providers from across the continuum of care to provide improved care for beneficiaries."

Like NAACOS, Premier also advocated for this adaptation, but Premier is "disappointed in the limited scope" of CMS' approach. They believe limiting the model to low-revenue ACOs creates "market distortions" by giving advantages to providers, and that ACO performance extends beyond revenue.

Aledade, the largest network of independent primary care in the country, also praised the feds' new model.

"After ten years of working with primary care practices nationwide we have heard firsthand concerns about resources needed to provide more primary care to those who need it and the flexibility to break free of rigid fee schedules," said Farzad Mostashari, M.D., co-founder and CEO, in a statement. "We are enthusiastic about the ACO Primary Care Flex Model, as it will rigorously test the proposition that giving primary care capitation payments as part of MSSP will drive adoption of accountable care and the enablement of proven services. Ultimately, we believe this model will generate within the U.S. healthcare system better outcomes, better quality and a better lower total cost of care."

"I think the upfront cash flow or financial resources that are being made available in this model is really going to transform the approach to patient care, particularly those patients that have the most need to or maybe most neglected or vulnerable in the fee for service model," said American Academy of Family Physicians CEO Shawn Martin.