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The Centers for Medicare & Medicaid Services (CMS) is committed to advancing health equity, expanding coverage, and improving health outcomes. To support this vision, the CMS Innovation Center announced an ambitious goal for the year 2030: to have 100% of beneficiaries in traditional Medicare and most Medicaid beneficiaries in accountable care relationships with providers who are responsible for the quality and the total cost of care, mostly through advanced primary care or accountable care organizations.
The National Academies of Sciences, Engineering, and Medicine (NASEM) report on primary care in 2021 highlighted its vital role in the health care system in promoting better population health and equitable outcomes. However, Medicare beneficiaries are facing greater clinical and system complexity requiring better coordination of primary and specialty care. Nearly 30% of beneficiaries have 2 or 3 chronic conditions, 22% have 4 or 5, and 18% have 6 or more. Furthermore, the proportion of beneficiaries seeing 5 or more physicians annually increased from 18% to 30% between 2000 and 2019.
The Innovation Center has tested models to increase access to advanced, integrated primary care in many communities. In doing so, it reviewed data and practice feedback from several primary care initiatives: the Comprehensive Primary Care (CPC) (2012-2015) and Comprehensive Primary Care Plus (CPC+) (2017-2021) models and the Primary Care First (PCF) (2021-2026) model. Five major lessons emerged from this review.