ACO PC Flex
ACO Primary Care Flex Model
The ACO Primary Care Flex (ACO PC Flex) Model is a 5-year voluntary model tested within the Medicare Shared Savings Program. It provides prospective payments and increased funding for primary care to empower ACOs to use innovative, team-based, and person-centered approaches. The model aims to improve health outcomes, quality, and costs of care for Medicare beneficiaries.
Innovation
Tests enhanced and prospective primary care payments (PPC Payment) derived from average county primary care spending rather than historical volume, alongside a one-time Advance Shared Savings Payment.
The Problem
While high-quality, coordinated primary care enables people to have better health outcomes and greater life expectancy, workforce shortages and payment challenges hinder primary care delivery.
The Solution
The ACO PC Flex Model incentivizes the development of new ACOs and implements a prospective payment system to support providers to deliver high-quality primary care for people with Medicare.
Expected Outcomes
By increasing access to high-quality primary care, ACO PC Flex can enable people with Medicare to build healthier lives through evidence-based prevention, helping them to avoid illness and better manage chronic disease.
Strategy
The model expands access to preventive care and empowers beneficiaries to make informed health decisions.
Model Goals
- Reduce program expenditures
- Improve quality of care and health care outcomes
- Align financial incentives for primary care
- Increase access to high-quality, person-centered primary care
Patient Eligibility
Beneficiaries with Traditional Medicare assigned to an ACO participating in the ACO PC Flex Model.
- Enrolled in Traditional Medicare
- Assigned to a participating Shared Savings Program ACO
Provider Eligibility
Shared Savings Program ACOs and their primary care providers, including low revenue ACOs, FQHCs, and RHCs.
- Must be a Medicare Shared Savings Program ACO
- Primary care physicians (internal medicine, general practice, family practice, geriatric medicine, pediatric medicine)
- Non-physician practitioners (nurse practitioner, clinical nurse specialist, physician assistant)
- Federally Qualified Health Centers (FQHCs)
- Rural Health Clinics (RHCs)
Care Categories
Primary Care
CMS Benchmarks & Thresholds
financial
operational
population
Operational Friction Summary
Where operational friction is highest for this model.
In the ACO PC Flex model, prospective primary care payments are tied directly to attributed populations, meaning early identification is essential to fund and deploy expanded team-based care models.
To manage total cost of care and justify the prospective primary care payments, ACOs must track patient utilization across specialists, behavioral health, and post-acute settings in real-time.
While ACO PC Flex provides prospective payments for primary care, the ACO remains accountable for the population's total cost of care over the performance year, requiring tight management of chronic disease trajectories.
ACO PC Flex empowers primary care, but controlling total cost of care requires alignment with specialists and hospitals who still operate largely in a fee-for-service environment.
See how this model fits your organization
Answer three quick questions about your facility and get matched to the VBC models that fit your profile — with benchmark context from organizations like yours.
Start Assessment