The landscape of primary care in the United States is undergoing a significant transformation, with a push toward value-based primary care and accountable care organizations (ACOs). Advanced Primary Care (APC) models promote coordinated, patient-centered care that enhances health outcomes while controlling costs. The Centers for Medicare and Medicaid Services (CMS) aims for 100% of traditional Medicare beneficiaries to be in accountable care relationships by 2030. This article explores the role of APC in achieving value-based primary care and accountable care, supported by research and policy developments.
Advanced Primary Care and Accountable Care
APC emphasizes team-based care, expanded access, and comprehensive care coordination. According to a report by the National Academies of Sciences, Engineering, and Medicine (NASEM), high-quality primary care is associated with lower mortality rates, fewer hospital admissions, and reduced healthcare expenditures. APC models build on this foundation by integrating behavioral health, social determinants of health (SDOH) considerations, and digital health tools to ensure proactive, rather than reactive care.
ACO models have successfully incorporated APC principles to improve care coordination and efficiency. As of 2024, nearly half of traditional Medicare beneficiaries receive care through ACOs. The APC role is growing in Medicare and value-based primary care. The Medicare Shared Savings Program (MSSP), CMS’s ACO initiative, consistently delivers net savings while improving quality metrics, showing the financial and clinical value of APC-driven accountable care and value-based primary care.
Financial Sustainability and Payment Innovation
A key challenge in expanding APC and value-based primary care is financial sustainability. Traditional fee-for-service (FFS) models do not adequately support the comprehensive, team-based nature of APC. Hybrid payment approaches, blending population-based payments with FFS, have demonstrated success in supporting APC initiative. CMS’s Making Care Primary (MCP) Model, launched in 2024, is an approach with incremental payment pathways to help independent primary care practices transition to value-based models.
The new introduction of the Advanced Primary Care Management (APCM) codes in the 2025 Medicare Physician Fee Schedule represents another step toward financial sustainability. These codes bundle care management services such as chronic disease management and care transitions, reducing administrative burden while ensuring adequate reimbursement for APC CMS Innovation Center models, including Comprehensive Primary Care Plus (CPC+) and Primary Care First, supports the effectiveness of these bundled payments in enhancing care quality and efficiency.
Equity and Accessibility in APC and Value-Based Primary Care Models
Equity remains a focal point in APC and value-based primary care expansion. Data from the ACO Realizing Equity, Access, and Community Health (ACO REACH) model indicate that financial incentives tied to health equity benchmarks can significantly increase participation from safety-net providers and improve outcomes for underserved populations. In 2025, the MSSP will integrate a health equity benchmark adjustment based on ACO REACH experiences, further embedding equity into APC and value-based primary care frameworks.
The MCP Model demonstrates a commitment to equity by ensuring that 41% of its participants are federally qualified health centers (FQHCs). These facilities predominantly serve low-income and minority populations. By aligning financial incentives with care quality improvements for vulnerable populations, APC and value-based primary care models can address longstanding health disparities and improve population health.
The Future of Advanced Primary Care in Medicare
The Medicare Shared Savings Program continues to evolve, incorporating insights from APC and value-based primary care models to refine attribution methodologies and expand provider participation. Additionally, testing the ACO Primary Care Flex Model within the MSSP in 2025 will further inform strategies for aligning primary care investment with accountable care and value-based primary care objectives.
Future APC models may explore hybrid primary care payment options, further integrating population-based payments into the Medicare Physician Fee Schedule. By incorporating lessons from CMS Innovation Center programs and maintaining provider flexibility, these approaches can ensure the long-term viability of APC and value-based primary care within Medicare.
Understanding Care Expansion
Advanced Primary Care is foundational to achieving high-quality, cost-effective healthcare under and accountable care models. With financial reforms, equity-focused initiatives, and continued policy evolution, CMS is advancing a sustainable framework for APC and value-based primary care expansion. As research and pilot programs continue to shape these models, the role of APC in delivering comprehensive, patient-centered care will only grow, reinforcing its critical function in Medicare’s future.
