Email UpdatesPrimary care is a crucial cornerstone of the U.S. healthcare system, yet it is understaffed and underinvested; only five to seven cents of every health care dollar is spent on primary care. The U.S. primary care system falls behind other countries on a number of metrics, including long-standing patient-provider relationships, home visit accessibility, and care coordination. The Centers for Medicare & Medicaid Services (CMS) is prioritizing primary care in two upcoming funding initiatives intended to instill critical operational and workflow changes within the primary care community.
These two new CMS initiatives aim to increase investment in primary care and to re-establish stability and flexibility in the primary care field. The CMS Innovation Center’s new model, ACO Primary Care Flex, endeavors to increase funding for primary care in Accountable Care Organizations (ACOs) to ultimately improve health outcomes, care quality, and care costs. This new payment model begins in January 2025 and will blend fee-for-service and prospective payment elements. In CMS’s 2025 Medicare Physician Fee Schedule Proposed Rule, CMS will provide a monthly prospective payment to physicians who treat Medicare beneficiaries with chronic illnesses to encourage care coordination and integration.
To learn more about how the CMS Innovation Center plans to support primary care, please see the CMS infographic on new and upcoming models to strengthen primary care. For state-specific reports on the status of primary care, refer to the 2024 Scorecard Data Dashboard. To understand more about financial sustainability for integrated behavioral health, see the AHRQ Academy Integration Playbook. For further reading about financing and sustainability in relation to integrated care, refer to the AHRQ Academy Literature Collection.