Health Affairs May 1, 2024
On March 19, 2024, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary model—the Accountable Care Organization (ACO) Primary Care Flex Model (ACO PC Flex Model)—which will test primary care capitation in CMS’s permanent ACO program, the Medicare Shared Savings Program (MSSP). Under the model, monthly prospective primary care payments to MSSP ACOs will replace fee-for-service payments to primary care providers. The MSSP ACOs will, in turn, be responsible for distributing payments to primary care participants. The model aims to improve the predictability of primary care revenue and incent enhanced primary care services not covered under fee-for-service. Here, we discuss the model, the restrictions on participation, and how these factors may impact the ACO market.
While the...
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