Learn about the three latest payment models putting your specialty at the center of a strategy to ensure that all Americans have access to high-quality, affordable, and person-centered care.
What is the Center for Medicare and Medicaid Innovation?
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.
Announced in June 2023, the Making Care Primary (MCP) model includes three tracks that each focus on goals aimed at creating pathways to enter value-based payment. MCP will launch in 2024. The application period is closed.
Making Care Primary aims to:
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 (PCF) practices, current Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model participants, and grandfathered tribal federally qualified health centers (FQHCs). Concurrent participation in MCP and the Medicare Shared Savings Program (MSSP) will not be allowed after the first six months of the model.
The model includes three tracks that each focus on specific goals. The AAFP has created profiles and a calculator to help you understand the tracks and potential revenue gains.
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 (SDOHs) 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.
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 are able to earn increased financial rewards for improving outcomes.
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.
Watch a recorded webinar about the program, hosted by CMS, the AAFP, and the ACP.
Primary Care First (PCF) aims to provide increased flexibility to primary care physicians to support innovative care delivery approaches based on patient population needs and preferences. It is a voluntary five-year, multipayer model being tested in 26 regions. Applications to participate are currently closed.
PCF alters the payment structure for primary care clinicians from traditional fee-for-service (FFS) to prospective payments with a potential bonus. Practices in model receive payments for primary care services through three mechanisms:
About ACO REACH
The ACO Realizing Equity, Access, and Community Health (ACO REACH) Model has three key aims:
ACO REACH (previously call the Global and Professional Direct Contracting Model) is a five-year voluntary model that began in April 2021 and includes two voluntary risk-sharing options. In each option, participating providers accept Medicare claims reductions and receive at least some of their compensation from their ACO.
The two participation options are: