CMS to launch new primary care ACO program

CMS to launch new primary care ACO program Hayley DeSilva

The Centers for Medicare and Medicaid Services plans to set up new primary care payments for low-revenue Accountable Care Organizations starting in 2025.

The Centers for Medicare and Medicaid Services laid out a new program Tuesday that would give primary care-focused Accountable Care Organizations upfront funds to help with set-up costs, as well as set monthly payments starting in 2025.The ACO Primary Care Flex Model aims to ease financial burdens for low revenue ACOs while encouraging tailored patient care and a focus on health equity, CMS said. One-time advanced shared savings payments of $250,000 are meant to help providers with the costs of forming an ACO, as well as administrative costs tied to program participation, according to a news release. The monthly, prospective payments would replace Medicare fee-for-service pay for primary care.Related article: Health insurers retreat from ACO REACHCMS said the set monthly funds would make pay for primary care more predictable and flexible.“People whose primary care provider participates in the ACO PC Flex Model may get care in more convenient ways, like care based at home or through virtual means, extra help managing chronic diseases, and more preventive health services to keep them healthy,” Chiquita Brooks-LaSure, CMS administrator, said in a news release. “Not only will people with Medicare receive more coordinated, seamless care that addresses their unique needs, but CMS is supporting primary care clinicians and giving them more flexibility to provide person-centered care.”Rates for the prospective primary care payments will be tied to the average spending in an ACO's county, which will be the benchmark for the cost of primary care in each area. CMS expects most participants would see more primary care funding through the monthly payments than they would with fee-for-service pay.

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EMAIL ADDRESS The new program will be tested within the Medicare Shared Savings Program. It is set to launch Jan. 1 and run for five years. CMS plans to select about 130 ACOs to participate, but they must apply to the larger ACO model before applying to be part of the new program. Applications are slated to be released in the second quarter of this year.The ACO PC Flex Model will be open only to low revenue ACOs, which tend to be smaller and comprised of mostly physicians, CMS said. But the National Association of ACOs, which supports the initiative, said the program should be expanded to include high revenue ACOs."While we are extremely pleased with the model, we ask that CMS reconsider excluding high-revenue ACOs, which prevents independent primary care practices who have partnered with their local health systems from taking advantage of these much needed innovations," Clif Gaus, president and CEO of NAACOS said in a statement Tuesday. "The premise of ACOs is to bring together providers from across the continuum of care to provide improved care for beneficiaries."