On March 19, 2024, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new accountable care organization (ACO) model within the Medicare Shared Savings Program (MSSP) focused on nurturing team-based, person-centered primary care. The five-year model, called ACO Primary Care Flex, will provide a one-time advanced shared savings payment and monthly prospective primary care payments (PPCPs) to the participating ACOs. The goal is to enhance primary care funding and incentivize team-based care approaches to medical and social needs. The use of team-based care is anticipated to contribute to lower total cost of care while preserving or enhancing the quality of care.
The model will focus on and invest in low revenue ACOs, which tend to be smaller and mainly made up of physicians. A low revenue ACO is one in which total Medicare Parts A and B fee-for-service revenue is less than 35% of the total Medicare Parts A and B fee-for-service expenditures for the ACO’s assigned beneficiaries. In the announcement, CMS said low revenue ACOs have historically performed better in the MSSP compared to high revenue ACOs, demonstrating more savings and stronger potential to improve the quality and efficiency of care delivery.
The upfront advanced shared savings payment is intended to provide the participating ACOs with needed resources and flexibility to cover costs associated with forming an ACO (where relevant) and administrative costs for required model activities. All ACO Primary Care Flex Model participants will receive an upfront payment of $250,000.
The monthly PPCPs will be distributed by the participating ACOs to the primary care practices participating in their ACO. The monthly payment will replace fee-for-service reimbursement for primary care services for all primary care provider organizations, federally qualified health centers, and rural health centers participating in the ACO. The PPCP is anticipated to give primary care practices sufficient resources and flexibility to provide care that best suits individuals’ needs. CMS will base the PPCP rates on county average spending, amplified by characteristics of the ACO, and the aligned beneficiary population to more accurately reflect the cost of providing comprehensive primary care to underserved populations.
Organizations interested in participating in the ACO Primary Care Flex Model must apply to the MSSP either as new ACOs or renewing ACOs. CMS will accept MSSP applications from May 20, 2024 to June 17, 2024. CMS plans to release the ACO Primary Care Flex Model request for applications during the second quarter of 2024, and intends to select about 130 MSSP ACOs to participate. The ACO Primary Care Flex Model is slated to begin on January 1, 2025.
For more information, contact: Office of Communications, U.S. Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Website: https://www.cms.gov/priorities/innovation/innovation-models/aco-primary-care-flex-model/faqs
November 2024 00US24EUA0065