ACP plans to work with CMS to ensure that financial support for this model reaches the primary care practices most in need
April 5, 2024 (ACP) -- The American College of Physicians has been an advocate for new models to support primary care and is encouraged that the Centers for Medicare and Medicaid Services Center for Medicare and Medicaid Innovation will begin testing a new practice model designed to support primary care medicine.
"ACP has advocated for testing new models that would better support primary care practices," said Dr. Omar T. Atiq, president of ACP. "We are glad to see that the ACO (Accountable Care Organization) Primary Care (PC) Flex Model is going to test the impact of increased funding for primary care on health outcomes, quality and cost of care within the Medicare Shared Savings Program."
The five-year voluntary model will go into effect on Jan. 1, 2025. According to CMS, the model will gauge the impact of prospective payments and increased funding for primary care in ACOs.
"People often experience better health outcomes and greater life expectancy when they receive high-quality, coordinated primary care," CMS said in a fact sheet. "Improved funding for primary care has the potential to amplify these positive outcomes, especially for underserved populations. The ACO PC Flex Model aims to increase access to high-quality primary care for people with Medicare by improving funding and other resources to enhance primary care in ACOs."
CMS added that the model "will incentivize the development of new ACOs, particularly those that will support underserved communities, and can help address health disparities."
Atiq added that "despite these proven benefits, primary care medicine is in crisis. ACP looks forward to reviewing the details of the model when they are released and working with CMS to ensure that the financial support for this model reaches the primary care practices that need it."
Here are more details about the ACO PC Flex Model from CMS:
- The voluntary model is scheduled for a five-year test. To participate, an ACO must take part in the Shared Savings Program and be a low-revenue ACO.
- According to CMS, the model "aims to increase the number of low-revenue ACOs in the Shared Savings Program. Low-revenue ACOs tend to be mainly made up of physicians and might include a small hospital or serve rural areas. They have historically performed better in the Shared Savings Program, demonstrating more savings and stronger potential to improve the quality and efficiency of care delivery."
- A new Prospective Primary Care Payment (PPCP) option "will shift payment for primary care away from fee-for-service, visit-based payment to enhance the predictability and amount of primary care funding for low-revenue ACOs, thus increasing their flexibility to meet the needs of people with Medicare. The model also includes a one-time Advanced Shared Savings Payment to help cover costs associated with forming an ACO and administrative costs for model activities," CMS explains.
- There will be a "regionally consistent rate" for primary care spending. The monthly PPCP will be made up of a County Base Rate (based on a county's average primary care spending before social and clinical risk factors are applied) and Payment Enhancements, "which are intended to provide additional resources to ACOs to support increased access to primary care, provision of care and care coordination," CMS writes. Payment Enhancements "will not be put at risk, meaning they will not be recouped by CMS. This will increase the long-term predictability and stability of primary care resources."
- A one-time Advanced Shared Savings Payment will be available "to help cover costs associated with forming an ACO and administrative costs for model activities."
According to CMS, it is planning to select approximately 130 ACOs to participate. Organizations interested in participating must first apply -- either as new ACOs or renewing ACOs -- to the Shared Savings Program. ACOs currently participating in the Shared Savings Program and interested in participating in the ACO PC Flex Model must apply to the Shared Savings Program as a Renewal Applicant and begin a new agreement period. In Phase 1 of the Shared Savings Program application, ACOs will be asked to indicate their interest in participating in the ACO PC Flex Model.
A request for ACO PC Flex Model applications is expected to be released by June. The initial submission period to apply to the Shared Savings Program closes on June 17, 2024.
Back to the April 5, 2024 issue of ACP Advocate