The U.S. Department of Health and Human Services (HHS), operating through the Centers for Medicare and Medicaid Services (CMS) Innovation Center, has unveiled an innovative healthcare approach with the ACO Primary Care Flex Model. This voluntary initiative empowers primary care providers within eligible Accountable Care Organizations (ACOs) to revolutionize the treatment of Medicare recipients through proactive, team-based, person-centered care.
Under the ACO Primary Care Flex Model, participating ACOs receive a one-time advanced shared savings payment and monthly prospective primary care payments. These financial boosts aim to furnish ACOs with the necessary resources and flexibility to cover formation costs and administrative expenses, ensuring seamless integration of the model's required activities. The monthly payments, distributed by ACOs to primary care practices, promise enhanced resources and flexibility for delivering tailored care that meets individuals' unique needs.
Aligned with the overarching goal of bolstering primary care, the ACO Primary Care Flex Model strongly emphasizes health equity and addressing disparities in primary care. By promoting team-based care and incentivizing approaches that cater to medical and social needs, the model drives savings in overall care costs and maintains or elevates the quality of care provided.
Implemented within the Medicare Shared Savings Program, the CMS Innovation Center will pilot this groundbreaking model.
The initiative prioritizes low-revenue ACOs, typically comprising smaller physician-dominated entities, as it seeks to amplify the program's success by investing in entities that historically demonstrated better performance and greater potential for enhancing care delivery efficiency and quality.
Furthermore, the payment structure of the ACO PC Flex Model fosters healthy competition by offering a pathway for resource-constrained, low-revenue ACOs to continue serving Medicare beneficiaries. The Flex Model payment structure also presents an attractive option for physicians wishing to maintain their independence within the healthcare landscape.
The ACO PC Flex Model, scheduled to commence on January 1, 2025, represents a five-year voluntary commitment. CMS plans to select approximately 130 ACOs to participate in this transformative initiative. Interested organizations, whether new or renewing ACOs, must first apply to the Shared Savings Program. The Shared Savings Program Applications window is May 20, 2024, to June 17, 2024, with the release of the ACO PC Flex Model Request for Applications (RFA) expected in the second quarter of 2024.
