ACOs can now request applications for this new prospective payment model

Some accountable care organizations (ACOs) can now apply for a new Center for Medicare and Medicaid Innovation payment model designed to integrate prospective primary care payments into the Medicare Shared Savings Program (MSSP). The ACO Primary Care Flex Model (ACO PC Flex) will launch Jan. 1, 2025, and aims to do the following:

• Expand access to high-quality, accountable care and improve the patient experience for Medicare beneficiaries,
• Enhance primary care payment and spur innovative approaches to care delivery, such as team-based care that is proactive and person-centered and drives quality improvement,
• Reduce disparities in health outcomes,
• Reduce program expenditures while preserving or enhancing the quality of care for people in the MSSP,
• Strengthen participation incentives for new ACOs and low-revenue ACOs in the MSSP.

ACO PC Flex includes two payment components: 1) a one-time advanced shared savings payment of $250,000 to all participating ACOs and 2) a monthly prospective primary care payment to ACOs and their participating primary care providers, including Federally Qualified Health Centers and Rural Health Clinics, to address the medical and health-related social needs of their patients. The monthly prospective payment will include these two components:

• The County Base Rate, based on average county-level primary care spending (before clinical or social risk adjustment is applied). It will be included in the MSSP total cost of care calculations.
• The Enhanced Amount, additional funding to support primary care access and care coordination. It will not be considered as part of the MSSP total cost of care — meaning these dollars will not be reconciled or recouped.

The model will be available to up to 130 new or renewing low-revenue ACOs who complete their MSSP application by June 17, 2024. The ACOs will also be required to complete the ACO PC Flex application by Aug. 1.

The request for applications is available now. Additional information can be found on the ACO PC Flex webpage and in this press release. More details on the model will be provided during a Centers for Medicare & Medicaid Services webinar 2:00 p.m. ET, June 6, 2024. Questions may be directed to ACOPCFlex@cms.hhs.gov.

— Kate Freeman, Manager, Market Transformation, AAFP

Posted on May 30, 2024