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CMS to Launch New Primary Care ACO Model in 2025

Innovative ACO Primary Care Flex Model Aims to Enhance Medicare Services for Low-Revenue Providers

March 28, 2024  – In a new development for primary care providers, the Centers for Medicare & Medicaid Services (CMS) is set to test a new accountable care organization (ACO) model. The ACO Primary Care Flex Model, or ACO PC Flex Model, represents a strategic effort by CMS to boost primary care within its Medicare Shared Savings Program (MSSP).

Scheduled for a five-year run beginning January 1, 2025, the ACO PC Flex Model targets MSSP participants characterized by lower revenue, which commonly includes smaller ACOs predominantly comprised of physician practices. This new model is designed to empower primary care providers to embrace “innovative, team-based, person-centered proactive care,” as detailed in the CMS announcement.

Selected ACOs participating in this program will benefit from financial incentives, including an initial advanced shared savings payment of $250,000 and monthly prospective, population-based payments, termed Prospective Primary Care Payments (PPCP). These 130 chosen ACOs, both newcomers and existing entities within the MSSP, are anticipated to leverage this model to deliver more coordinated and effective care to their patients.

“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. “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. HHS will continue building on the Affordable Care Act, which not only brought more people coverage, but allowed us to develop innovative models that foster quality care, improve outcomes, reduce costs, expand access to services, and advance health equity.”

The ACO PC Flex Model is designed to test whether increased primary care payments can drive ACOs and their providers towards adopting more innovative, team-oriented care approaches that significantly improve health outcomes and cost-efficiency. Additionally, the model seeks to mitigate health disparities and augment MSSP participation rates.

Amid fluctuating interest levels in the MSSP, with participation peaking in 2018 and witnessing a gradual decline thereafter, this new model aims to rejuvenate ACO engagement. The MSSP has seen varying degrees of participation, particularly following the introduction of Pathways to Success and the challenges posed by the COVID-19 pandemic.

By focusing on primary care providers, including federally qualified health centers (FQHCs) and rural health clinics, the ACO PC Flex Model aims not only to enhance participation but also to align with broader CMS goals, such as promoting health equity. The application period for this model will be open from May to August 2024, inviting both new and renewing ACOs to apply to the MSSP and partake in this innovative primary care initiative.

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