activevoluntarypopulation-based

ACO PC Flex

Accountable Care Organization Primary Care Flex Model

The ACO Primary Care Flex (ACO PC Flex) Model tests how prospective payments and increased funding for primary care in Accountable Care Organizations (ACOs) effects health outcomes, quality, and costs of care within the Medicare Shared Savings Program. The voluntary model started January 1, 2025, and runs through 2029.

Active Since2025-01-01

Innovation

The model tests enhanced and prospective primary care payments (a one-time Advance Shared Savings Payment and monthly Prospective Primary Care Payments) to enable more team-based, proactive, and person-centered care, moving away from visit-based payment mechanisms in fee-for-service Medicare.

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 for Medicare beneficiaries
  • Align financial incentives for primary care
  • Emphasize flexibility and primary care innovation
  • Ensure beneficiaries receive access to high-quality, person-centered primary care

Patient Eligibility

Beneficiaries with Traditional Medicare who are assigned to an ACO participating in the ACO PC Flex Model.

  • Must be enrolled in Traditional Medicare
  • Assigned to a participating Shared Savings Program ACO

Provider Eligibility

ACOs and their primary care providers that jointly participate in the Medicare Shared Savings Program and are approved for the ACO PC Flex Model.

  • Must participate in the Medicare Shared Savings Program
  • Must be included on the PPCP-Eligible Participant List
  • Primary care physicians must have specialty designations of internal medicine, general practice, family practice, geriatric medicine, or pediatric medicine
  • Non-physician practitioners must include specialty designations of nurse practitioner, clinical nurse specialist, or physician assistant

Care Categories

Primary Care

Preventive careChronic disease managementCare managementPatient navigationBehavioral health integrationCare coordination

Program Benchmarks & Thresholds

financial

PPCP Fee Reduction Deferral Percentage0.25%
Minimum Spend on Advanced Primary Care (First Year)0.9%
Maximum Spend on ACO Operations (First Year)0.1%
Maximum Spend on Prohibited Uses0%
Minimum Spend on Advanced Primary Care (Subsequent Years)0.95%
Maximum Spend on ACO Operations (Subsequent Years)0.05%

operational

Number of Participants23
Model Start Year2,025
Model End Year2,029
Typical Implementation Timeline60

population

Typical Beneficiary Count5,000

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