Biden Administration Launches New Model to Boost Primary Care in Medicare

The Biden administration has announced a new initiative aimed at strengthening primary care for Medicare beneficiaries. The five-year voluntary program, named ACO Primary Care Flex, will provide financial incentives to participating healthcare organizations.

Increased Investment in Primary Care

The program, overseen by the Centers for Medicare & Medicaid Services (CMS), will offer two key financial benefits to accountable care organizations (ACOs) that participate. First, ACOs will receive a one-time upfront payment to invest in infrastructure and care improvements. Second, they will receive regular monthly payments instead of waiting for a lump sum at the end of a performance period, which is the current system.

This shift to predictable monthly payments is expected to improve cash flow for primary care practices, many of which operate on tight budgets. Industry leaders see this as a positive step. “Shifting to prospective payments will give primary care practices a more stable and predictable cash flow,” said National Association of ACOs President and CEO Clif Gaus.

Improved Patient Care Through Team-Based Approach

The ACO Primary Care Flex program also aims to enhance patient care by encouraging a team-based approach. This means primary care physicians will have more flexibility to collaborate with other healthcare professionals to manage their patients’ needs. This could include specialists, nurses, and social workers.

According to CMS Administrator Chiquita Brooks-LaSure, patients whose primary care doctors participate “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.”

Selection Process and Concerns

The CMS plans to select approximately 130 ACOs to participate in the program. However, there have been concerns raised about eligibility. The program is limited to “low-revenue ACOs,” which are defined as organizations with Medicare revenue below a specific threshold.

This exclusion has been criticized by some who believe it prevents larger, established healthcare systems from participating. The National Association of ACOs has urged the CMS to reconsider this limitation.

Program Timeline and Next Steps

The ACO Primary Care Flex program will be implemented within the existing Medicare Shared Savings Program, a major value-based payment program. Applications for the program are expected to open in the second quarter of 2024.

This initiative reflects the Biden administration’s broader goal of expanding value-based care models in Medicare. The Center for Medicare and Medicaid Innovation (CMMI), established by the Affordable Care Act, is leading this effort. The CMMI aims to have all 34 million traditional Medicare beneficiaries enrolled in value-based care arrangements by 2030.

Sources

www.healthcaredive.com/news/cms-launches-primary-care-medicare-model-aco/710738/

 

 


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