Center for Medicare and Medicaid Innovation primary care models
Learn about CMS primary care models and how they impact family medicine practices.
Primary care is the center of CMMI’s strategy to ensure all Americans have access to high-quality, affordable and person-centered care.
Center for Medicare and Medicaid Innovation (CMMI) FAQs
What is CMMI?
CMMI is a part of the Centers for Medicare & Medicaid Services (CMS) within the U.S. Department of Health and Human Services. CMMI was created by the Affordable Care Act (ACA) in 2010 to test new payment and service delivery models that could improve care quality and efficiency for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. Elevating primary care is central to the Innovation Center’s strategy.
What is a CMMI model?
CMMI models are pilot programs designed to test innovative delivery and payment systems that aim to improve patient outcomes and lower health care costs. Models target a variety of participants, including primary care practices, accountable care organizations, pharmaceutical manufacturers, health technology vendors and more. When models are announced, interested participants apply during a set period; those accepted engage in the model through a specified timeline.
New and enrolling CMMI models
ACCESS (Advancing Chronic Care with Effective, Scalable Solutions), LEAD (Long-term Enhanced ACO Design) and ELEVATE (Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence) are three new CMMI models that could help your practice explore new value-based care pathways. Get familiar with your options as the AAFP advocates for more details and direction in 2026.
About ACCESS
ACCESS focuses on technology-supported care for chronic conditions. The voluntary model tests outcome‑aligned payments in original Medicare over a 10-year period, with the goal of expanding access to technology‑supported care for common chronic conditions and improving patient outcomes through innovative, scalable care solutions.
Who can apply and participate?
ACCESS is designed for Medicare Part B–enrolled clinicians and suppliers delivering technology‑supported chronic care services.
How does ACCESS affect primary care?
While this model primarily focuses on health technology vendors, it presents potential oversight and patient safety concerns. The AAFP has asked CMS for more details.
What are the application details for ACCESS?
Applications for the first cohort of ACCESS, which will launch in late 2026, must be submitted by April 1, 2026. Learn more about applying on the CMS website.
About MAHA ELEVATE
MAHA ELEVATE is a voluntary model that will provide $100 million in funding over three years for evidence-based, whole-health interventions. By investing in lifestyle and functional medicine proposals that support standard medical care but are not covered by original Medicare, CMMI aims to measure how activities that promote healthy lifestyle behaviors affect chronic disease, health outcomes and Medicare costs.
Who can apply and participate?
MAHA ELEVATE will fund 30 proposals from a mix of health systems, ACOs, FQHCs, RHCs, functional/lifestyle medicine practices, community organizations and similar entities. Selected applicants participate in a three-year cooperative agreement.
How does MAHA ELEVATE affect primary care?
MAHA ELEVATE could lead to increased access to, and payment for, evidence‑based lifestyle, nutrition, prevention and whole‑person care interventions that support chronic disease prevention but are not covered by Medicare.
What are the application details for MAHA ELEVATE?
Application details have not yet been released. The model is scheduled to launch on September 1, 2026. Learn more on the CMS website.
About LEAD
LEAD, the successor to CMMI's ACO REACH, is a 10‑year voluntary ACO model designed to expand accountable care organization participation—especially among smaller, rural and high‑needs‑serving clinicians—by offering predictable benchmarks, flexible payments and integrated care supports.
Who can apply and participate?
LEAD participation is open to and voluntary for:
- Established ACOs, including ACO REACH participants
- New ACOs
- High‑needs-serving clinicians in underserved settings, including RHCs and FQHCs
How does LEAD affect primary care?
CMMI designed LEAD to help primary‑care‑centered ACOs develop necessary infrastructure to better serve specific patient populations and prevent and manage chronic disease by providing financial support and flexibility.
What are the application details for LEAD?
Application details have not yet been released. The model is scheduled to launch on January 1, 2027. Learn more on the CMS website.
Featured webinar
Watch a family medicine–oriented presentation on LEAD, a new ACO benchmarking model from CMMI. This webinar features CMS model leads for LEAD and AAFP government relations staff discussing methodology, differences between ACO REACH and LEAD and more.
Email questions to LEAD@cms.hhs.gov | Visit the LEAD Model webpage to view webinar slides or download an overview resource or value factsheet | Sign up for updates about LEAD via the LEAD Model Listserv
Nine reasons to try value-based payment
Launched and active CMMI models
Overview
ACO Primary Care Flex was announced in March 2024 and is designed to implement prospective primary care payment into the Medicare Shared Savings Program. The ACO Primary Care Flex launched in 2025. ACO Primary Care Flex aims to:
Expand access to high-quality, accountable care and improve the patient experience for people with Medicare.
Enhance primary care payment and spur innovative approaches to care delivery, such as proactive, person-centered team-based care that drives quality improvement.
Narrow disparities in health care outcomes.
Reduce program expenditures while maintaining or improving the quality of care for individuals in the Shared Savings Program (SSP).
Strengthen participation incentives for new and low-revenue ACOs in the SSP.
Payment design
ACO Primary Care Flex includes two main payment components:
A one-time $250,000 advanced shared savings payment to all participating ACOs.
A monthly prospective primary care payment to ACOs and their participating primary care providers, including federally qualified health centers and rural health clinics, to address the medical and health-related social needs of their patients.
Eligibility
ACO Primary Care Flex will be available to up to 130 new or renewing low-revenue ACOs that complete their SSP application by June 17, 2024.
ACOs will also be required to complete the ACO Primary Care Flex application in addition to the SSP application.
ACOs may not participate in Primary Care Flex if they receive Advance Investment Payments through the SSP. Primary care physicians and other clinicians not affiliated with a participating ACO are ineligible to participate.
Overview
Announced in June 2023, the Making Care Primary model includes three tracks that each focus on goals aimed at creating pathways to enter value-based payment through this pilot model. The application period is closed.
Making Care Primary aims to:
Ensure patients have access to and receive primary care that is integrated, coordinated, person-centered and accountable.
Create a pathway for primary care organizations and practices, especially small, independent, rural and safety net organizations, to enter value-based arrangements.
Improve quality of care and health outcomes for patients while reducing program expenditures.
Payment design
The model includes three tracks that each focus on specific goals.
Track 1: Building infrastructure
Participants work to establish a foundation for implementing advanced primary care services, such as patient risk stratification, data review, workflow development, chronic disease management and social determinants of health screening and referral. Payment for primary care will remain fee-for-service (FFS)-based while CMS provides financial support to help participants develop care transformation infrastructure and build advanced care delivery capabilities. Participants begin earning financial rewards for improving patient health outcomes.
Track 2: Implementing advanced primary care
Participants build on Track 1 requirements by partnering with social service professionals and specialists, implementing care management services and screening for behavioral health conditions. Payment for primary care will shift to a 50/50 blend of prospective, population-based payments and FFS payments. CMS will continue some financial support for building advanced care delivery capabilities, even as participants can earn increased financial rewards for improving outcomes.
Track 3: Optimizing care and partnerships
Participants begin using quality improvement frameworks to optimize and improve workflows, address silos to improve care integration, develop social services and specialty care partnerships, and deepen connections to community resources. Payment for primary care will shift to fully prospective, population-based payment while CMS continues minimal financial support to sustain care delivery activities. Participants can earn even greater financial rewards for improving patient health outcomes.
Use these profiles to learn how the tracks can benefit family medicine practices. Then, download a calculator that helps with assessing the potential financial impact of participating in Making Care Primary.
Eligibility criteria
The model will be tested in eight states based on agreements with state Medicaid agencies regarding alignment around program principles and model dimensions that matter to family physicians. The eight states are Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington.
Organizations ineligible to participate include rural health clinics, concierge practices, current Primary Care First practices, current ACO realizing equity, access and community health (ACO REACH) model participants, and grandfathered tribal federally qualified health centers. Concurrent participation in Making Care Primary and the Medicare Shared Savings Program will not be allowed after the first six months of the model.
Overview
Primary Care First, launched in 2021, is a five-year model designed to give primary care physicians greater flexibility to deliver care tailored to patient needs and preferences. It is a voluntary, multi-payer model being tested in 26 regions. Applications to participate are currently closed.
Payment design
Primary Care First alters the payment structure for primary care clinicians from traditional FFS to prospective payments with a potential bonus. Practices participating in the model receive payments for primary care services through three mechanisms:
The total primary care payment, which is made up of a risk-adjusted population-based payment (ranging from $28 to $175 per-beneficiary per-month [PBPM] based on average panel risk) and a flat visit fee (~$40) for each face-to-face primary care visit.
A performance-based adjustment paid quarterly based on five quality measures and performance on acute hospital utilization. The performance-based adjustment applies to total primary care revenue and ranges from -10% to a bonus of up to 50%.
Standard FFS payment for services provided outside those covered by the flat visit fee, such as procedures and vaccines.
Eligibility criteria
Primary Care First was available to practices located in 26 designated regions across the United States. Eligible applicants included primary care practices that:
Delivered advanced primary care services (e.g., continuity of care, care management, patient engagement)
Had experience with value-based payment or care delivery transformation
Used certified electronic health record (EHR) technology
Met minimum thresholds for primary care revenue and service volume
Participation was limited to practices that were not concurrently participating in CPC+ or certain Medicare Shared Savings Program ACO arrangements. Applications are currently closed.
Overview
ACO REACH began in 2021 with the aim of promoting health equity, leadership and more. This model is currently being tested and is not accepting applications for participation. It has three key aims:
Advance health equity to bring the benefits of accountable care to underserved communities.
Promote provider leadership and governance.
Protect beneficiaries and the model with more participant vetting, monitoring and greater transparency.
Payment design
ACO REACH offers two voluntary risk-sharing options, professional and global, with varying levels of financial accountability and flexibility in payment design.
Professional option
Under the professional option, participating providers receive a monthly risk-adjusted capitation payment for enhanced primary care services and share 50% of any savings or losses.
Global option
The global option allows providers to choose between primary care capitation or total care capitation for all covered services. Under this option, providers take on 100% of shared savings or losses.
Both options include performance monitoring, risk adjustment and alignment with CMS health equity goals.
Eligibility criteria
ACO REACH is open to a range of provider organizations, including health systems, physician groups and ACOs that meet CMS requirements for risk-sharing and care coordination. Applicants must demonstrate:
Experience serving Medicare beneficiaries
Readiness to assume financial risk under one of the model’s participation options
Commitment to advancing health equity and reducing disparities
Inclusion of beneficiaries from underserved communities
Past CMMI model
CPC+ was a multi-payer, two-track primary care model that ran from 2017 through 2022. Designed to support practice transformation and improve outcomes, CPC+ tested advanced payment structures and care delivery strategies. Though the model is no longer active, it laid important groundwork for newer CMS Innovation Center initiatives, including Primary Care First and Making Care Primary.
CPC+ aimed to provide better, more flexible payment for primary care practices and to foster a robust learning community. The model de-emphasized traditional FFS and increased payment to support practice improvement and capacity building.