CMS announces new ACO model focused on primary care

CMS will test a new accountable care organization (ACO) model that focuses on primary care providers starting next year.

A recent announcement states that CMS will launch a five-year voluntary ACO model on January 1, 2025, as part of its flagship Medicare Shared Savings Program (MSSP). The model known as the ACO Primary Care Flex Model, or ACO PC Flex, will target low-revenue MSSP participants, which are typically smaller ACOs primarily made up of physicians.

The ACO PC Flex Model aims to support primary care providers like those in existing low-revenue ACOs as they implement “innovative, team-based, person-centered proactive care,” according to the announcement.

“People whose primary care provider participates in the ACO PC Flex Model may get care in more convenient ways, like care based at home or through virtual means, extra help managing chronic diseases, and more preventive health services to keep them healthy,” said CMS Administrator Chiquita Brooks-LaSure. “Not only will people with Medicare receive more coordinated, seamless care that addresses their unique needs, but CMS is supporting primary care clinicians and giving them more flexibility to provide person-centered care.”

The 130 ACOs selected to participate in the ACO PC Flex Model later this year will receive one-time advanced shared savings payment of $250,000 and monthly prospective, population-based payments, called Prospective Primary Care Payments (PPCP). The participating ACOs — whether new or existing — will also participate in the MSSP in addition to the ACO PC Flex Model.

According to a fact sheet, the latest ACO model from CMS “will test whether improved payment for primary care will empower participating ACOs and their primary care providers to utilize more innovative, team-based, person-centered and proactive approaches to care and positively impact health outcomes, quality and costs of care.”

Other goals of the model include reducing health disparities in outcomes and access to primary care and increasing participation in MSSP.

CMS wants all Traditional Medicare beneficiaries and a vast majority of Medicaid beneficiaries in accountable care relationships by 2030. However, interest in the MSSP, CMS’ largest accountable care model, has waned over the past couple of years. Participation numbers peaked in 2018 with 561 ACO participants but have not been as robust since. There are currently 480 ACOs participating in the MSSP, up from 456 ACOs last year.

Participation in the MSSP declined after the implementation of Pathways to Success, a policy initiative that aimed to transition ACOs to downside risk sooner, among other changes to the MSSP. The COVID-19 pandemic also impacted new ACO participation despite flexibilities granted during the public health emergency.

The ACO PC Flex Model targets ACOs and their participating primary care providers, including federally qualified health centers (FQHCs) and rural health clinics, to boost participation. The model also touches on other CMS goals, including advancing health equity.

The application for the model will open in May 2024 through August 2024. Both new and renewing ACOs must first apply to the MSSP.