Medicare to Start Taking Applications Next Month for a New Primary-Care Focused ACO

The Centers for Medicare & Medicaid Services (CMS) will begin accepting applications next month for a new type of accountable care organization (ACO) that is aimed at attracting primary care physicians who have not participated in an ACO before.

“Access to high-quality primary care is associated with better health outcomes and equity for people and communities,” the agency said last month in a press release. The new ACO model, called Making Care Primary (MCP) “is an important step in strengthening the primary care infrastructure in the country, especially for safety-net and smaller or independent primary care organizations.”

“The model seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and leveraging community-based connections to address patients’ health needs as well as their health-related social needs,” the release continued. It listed three goals for the new program:

• Giving patients “integrated, coordinated, person-centered and accountable” primary care
• Giving small, independent, rural, and safety-net primary care practices a way to enter “value-based” payment arrangements
• Improving care quality while cutting costs

ACOs are groups of doctors, hospitals, and/or other healthcare providers that work together with a goal of providing better care at a lower cost. CMS has launched several different ACO models over recent years with varying degrees of success; some earlier models, such as Comprehensive Primary Care (CPC), CPC+, and Primary Care First have specifically targeted primary care practices.

The new model, which is slated to run for 10.5 years beginning in July 2024, will be rolled out initially in eight states: Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, North Carolina, and Washington. The agency expects to begin accepting applications next month. And although the model is being implemented for Medicare patients, CMS said in a fact sheet that it is also “partnering with state Medicaid agencies and other payers in the listed MCP states to align MCP and state programs.”

The basic idea of the ACO models has been to encourage providers to move from fee-for-service payment to payment that rewards better patient outcomes. In the models, CMS often shares financial rewards with ACO participating providers if the care for Medicare beneficiaries at their ACO costs less than Medicare otherwise would have paid under traditional fee-for-service Medicare, and in some cases providers must pay back the difference if the ACO costs Medicare more than it otherwise would have spent. For practices new to ACOs, the MCP model — which has three different tracks — starts them out using fee-for-service payments but then moves them into a prospective payment system in which they receive a set monthly fee for each patient they take care of.

“It seems like they’re trying to broaden the base of who can participate and, maybe, create opportunities for independent practices,” Katherine Hempstead, PhD, senior policy advisor at the Robert Wood Johnson Foundation, said in a phone interview about MCP.

“Value-based care has been associated with promoting consolidation, hospital ownership practices — things that I think people wonder what the ultimate effect of that on competition and price is going to be,” she said. “A lot of practices feel under pressure to become acquired or maybe get involved in private equity in order to be able to participate in value-based care opportunities, but it seems to me that this is one of the things that they’re trying to make it available to entities that are solo practices and haven’t previously participated.”

Although practices participating in MCP will still have the same challenges as they might with other ACO models in terms of making sure their computer systems can handle the documentation and meeting the ACO’s other requirements, “they’re expressing openness to working with those kinds of partners … and trying to be attractive to entities that haven’t applied before,” she added.

The new model is in line with more general trends in this area, Hempstead said. “People feel like we’re still mostly in a fee-for-service world, and I feel like people would like to speed dissemination” of value-based care models.

In addition, “there’s this widespread perception that we don’t spend enough on primary care, and if we did we could prevent a lot of more serious complications down the road,” she said. “Is it true? I don’t think we really know if it’s true or not, but there’s a really strong incentive all across society … So I think that explains the gist of this model.”

ACO organizations have had mixed reactions to the new model. “Holding primary care physicians accountable for costs and quality is central to achieving the promise of value-based healthcare,” Susan Dentzer, president and CEO of America’s Physician Groups (APG), which represents physician-run ACOs, said in a statement when the MCP model was announced. “It’s therefore important to continue to provide accessible ‘on ramps’ for small practices to enable them to make what could otherwise be a difficult transition for them.”

“We at APG are especially excited that Track 1 of the model is explicitly designed for federally qualified health centers, which serve some of the nation’s most vulnerable patients,” she continued. “The model seeks to align payment across Medicare, Medicaid, and commercial payment where possible. These approaches are also vital to stimulating the spread of value-based care.”

But the National Association of ACOs (NAACOS), a more general ACO membership group, was not happy that practices who already participate in another ACO are not allowed to participate in the new model. “While aspects of the new model are positive, practices should not be forced to choose between Making Care Primary and participating in an ACO,” NAACOS president and CEO Clif Gaus, ScD, said in a statement. “To continue the shift to total cost of care models like ACOs, CMS needs to allow concurrent participation.”

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