Physician groups praise new Medicare primary care payment model, but ACOs have questions

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Physicians groups praised a new Medicare payment model that will start a 10-year test period in 2024.

But the advocate group for accountable care organizations (ACOs) questioned a potential limit on participation by physician practices already using that method.

On June 8, the U.S. Centers for Medicare & Medicaid Services (CMS) announced the new Making Care Primary Model (MCP) would begin in eight states starting next year. The goal is to improve access and quality of care patients, especially in rural and underserved areas, by helping primary care physicians better coordinate care for multiple chronic diseases, according to CMS. On June 9, the federal agency published an additional policy paper on the plan.

The American Academy of Family Physicians (AAFP) and the American Medical Association (AMA) voiced support for the MCP model. However, the National Association of ACOs (NAACOS) praised some elements of the model, but said it would force physicians to choose between MCP and participating in an accountable care organization.

‘Value-based primary care’

CMS’s new model will be implemented in eight states based on strong alignment with state Medicaid programs, AAFP Executive Vice President and CEO R. Shawn Martin said in a statement.

Meaningful practice transformation requires significant upfront investment, works best when multiple payers are involved and takes time, Martin’s statement said. CMS’ Center for Medicare and Medicaid Innovation recognizes that with a new model built on learning derived from other models, including Comprehensive Primary Care and Comprehensive Primary Care Plus.

“While details of the model are still forthcoming, family physicians are pleased to see that many aspects of CMMI’s new model reflect several of the recommendations for value-based primary care that the AAFP has been sharing with CMMI for several years,” Martin’s statement said. “It’s important to recognize that these efforts reflect increased investment in primary care and value-based care, which ultimately enables practices to innovate and improve patient and population outcomes.”

‘A voluntary, progressive model’

Using a longer test period and meaningful alignment with Medicaid match AMA’s recommendations, AMA President Jack Resneck Jr., MD, said in a statement. MCP is “a voluntary, progressive model that meets practices where they are and provides on-ramps for them to advance into prospective payment,” he said.

“The longer test period of 10.5 years directly responds to AMA efforts calling for more transparency and stability to foster trust and encourage physician participation,” REsneck said. “The AMA strongly believes value-based care models are essential to the long-term well-being of the Medicare program and its ability to meet the needs of a diverse and aging population.”

He said AMA appreciates the administration of President Joe Biden and its “ongoing work to improve patients’ equitable access to care and look forward to reviewing the details of the model when they become available.”

Seeking a better model?

NAACOS President and CEO Clif Gaus, ScD, said the association supports more investment in and population-based payments for primary care. The NAACOS approach would help CMS establish meets its goal of matching beneficiaries with providers responsible for costs and quality, Gaus’ statement said.

MCP is counter to those goals by excluding practices in accountable care organizations, Gaus said.

“Within ACOs, primary care practices are the quarterback of care teams, but they must work with providers across the care continuum to achieve quality outcomes and cost savings,” Gaus said.