Applications Now Open for MSSP Hybrid Pay Model Sought by PCC

Applications opened for ACOs and their primary care partners to join the new ACO Primary Care Flex, but PCC and its Better Health – NOW (BHN) partners continue to urge CMS to strengthen the model during implementation.

A May 9^th BHN letter conveyed appreciation for the new ACO Primary Care Flex Model, scheduled to start January 1, 2025, and offered specific recommendations aimed at successful implementation.

The letter, addressed to Center on Medicare Director Meena Seshamani and CMS Innovation Center Director Liz Fowler, called the model, a “substantive step to strengthen primary care for beneficiaries” and highlighted CMS’ commitment to guardrails that assure the model’s investments reach primary care.

However, the letter also highlighted opportunities to strengthen the model during implementation, including the following recommendations:

• Ensure affordability of primary care by offering additional cost-sharing relief for beneficiaries
• Continue dialogue with front-line clinicians and beneficiary advocates, as well as eligible ACOs, during implementation
• Track behavioral health and social care integration service utilization and expenditures, beginning in the model’s first year, and establish enhancements to the prospective, population-based payment components of the model for those practices that routinely furnish those services

ACO Primary Care Flex’s ACO PC Flex’s launch came less than a year after PCC and 30 other health care organizations urged CMS leaders to implement a hybrid program under MSSP.

PCC and its partners in the Better Health – NOW Campaign will be reviewing the details of the newly released Request for Applications.  As implementation proceeds, we will continue to engage with CMS leaders to ensure the model delivers meaningful opportunities for patients and primary care.