Medicare to launch primary care model for low-revenue ACOs

The Centers for Medicare & Medicaid Services expects to launch a voluntary primary care model in January 2025 for low-revenue accountable care organizations that participate in the Medicare Shared Savings Program. The ACO Primary Care Flex Model will provide a one-time advanced shared savings payment, monthly prospective primary care payments, and incentivizes to support team-based care approaches to medical and social needs. CMS expects to release a request for applications during second-quarter 2024 for submission by June 17 and select about 130 ACOs to participate.

“By giving ACOs more flexibility and additional funding and support to deliver high-value primary care, the ACO PC Flex Model can help providers identify and address people’s unmet health-related needs,” said Liz Fowler, CMS deputy administrator and director of the CMS Innovation Center. “This model strengthens incentives for more providers to form ACOs and meet CMS’ goal of increasing the number of people with Medicare who are in an accountable care relationship.” 

The AHA has urged CMS and Congress to stop designating ACOs as either low- or high-revenue, which is not an accurate or appropriate predictor of whether ACO’s treat underserved populations. The practice can also classify as high-revenue certain critical access hospitals, federally qualified health centers and rural health centers that need additional investment resources to transition to value-based models like ACOs.