Changing primary care incentives moves Traditional Medicare towards prevention

Primary care works best when it identifies risks early and manages chronic conditions before a health crisis occurs. Yet, traditional fee-for-service has long rewarded visits and procedures over proactive wellness. It reliably reimburses visits and procedures for treating acute events, like strokes and heart failure, but offers little budget or protected time to prevent them.

By shifting payment incentives away from volume, value-based care makes keeping patients healthy and out of the hospital the main driver of practice viability. It is now firmly rooted in federal statute and law, establishing a mature, stable framework proven to improve health outcomes and ensure long-term economic sustainability for independent primary care practices.

How the Medicare Shared Savings Program (MSSP) works

The Medicare Shared Savings Program (MSSP) is a permanent, voluntary accountable care program run within Traditional Medicare by CMS. Clinicians participating in MSSP continue standard patient visit billing, while MSSP adds an additional layer of value-based savings. Practices new to the program can get started in upside-only tracks, avoiding downside financial risk on day one. When proactive primary care successfully reduces the total cost of the patient’s care (compared to a historical benchmark) by preventing avoidable hospitalizations and emergency visits, Medicare returns those savings back to participating practices through their accountable care organization (ACO).

Recent CMS data underscores growing participation in MSSP:

• For performance year 2026, MSSP includes 511 ACOs representing more than 700,000 healthcare providers and organizations caring for 12.6 million Traditional Medicare patients—a 12.3% increase from 2025.¹
• As of January 2025, 53.4% of Traditional Medicare beneficiaries (14.8 million+ people) were aligned with an ACO, marking the largest single-year jump in CMS history.²

Why MSSP is the ideal vehicle for primary care

Primary care is the foundation of value-based care. Primary care physicians (PCPs) are uniquely positioned to see a patient’s overall health picture, enabling them to focus on early detection, chronic disease management and hospital diversion. This makes them the natural stewards of total cost and quality. Value-based care recognizes this foundational role and aligns payment with the preventive care PCPs already deliver.

The clinical and economic results speak for themselves. In the first eight years of the program alone, MSSP ACOs lowered costs to Medicare by an estimated $2.9 billion.³ Crucially, physician-led ACOs generated seven times the savings of hospital-led ACOs—proving that independent primary care delivers the strongest returns in value-based care.

For direct support in navigating MSSP options, connect with Aledade today.