Primary Care First Model Options

Primary Care First's final performance period ended on December 31, 2025.

Read more CMS Innovation Center Announces Model Portfolio Changes to Better Protect Taxpayers and Help Americans Live Healthier Lives

Primary Care First was a voluntary alternative five-year payment model that rewarded value and quality by offering an innovative payment structure to support the delivery of advanced primary care. In response to input from primary care clinician stakeholders, Primary Care First was based on the principles underlying the existing Comprehensive Primary Care Plus (CPC+) model design: prioritizing the clinician-patient relationship; enhancing care for patients with complex chronic needs, and focusing financial incentives on improved health outcomes.

Primary Care First was offered in 26 regions: Alaska (statewide), Arkansas (statewide), California (statewide), Colorado (statewide), Delaware (statewide), Florida (statewide), Greater Buffalo region (New York), Greater Kansas City region (Kansas and Missouri), Greater Philadelphia region (Pennsylvania), Hawaii (statewide), Louisiana (statewide), Maine (statewide), Massachusetts (statewide), Michigan (statewide), Montana (statewide), Nebraska (statewide), New Hampshire (statewide), New Jersey (statewide), North Dakota (statewide), North Hudson-Capital region (New York), Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky), Oklahoma (statewide), Oregon (statewide), Rhode Island (statewide), Tennessee (statewide), and Virginia (statewide).

Primary Care First included two cohorts of participating practices: Cohort 1 began in January 2021 and Cohort 2 began in January 2022.

There were approximately 1,700 practices participating in Primary Care First across both cohorts, and 17 payer partners. To view an interactive map of this Model, visit the Where Innovation is Happening page, and select this model from the drop-down menu on the left side of the page.

Select anywhere on the map below to view the interactive version
Source: Centers for Medicare & Medicaid Services

 

Highlights

  • Patients who do not regularly see a primary care doctor are significantly less likely to get regular health screenings, monitoring for emerging health issues, and other preventive health care. These patients may see their health issues worsen, causing them to seek higher cost care, such as hospitalization, trips to the emergency room, or greater need to use specialty care.
  • The Primary Care First model was designed to help primary care practices better support their patients in managing their health — especially patients with complex, chronic health conditions — and enabled primary care doctors to offer a broader range of health care services that met the needs of their patients. For example, practices could offer around-the-clock access to a clinician and support for health-related social needs.
  • Strengthening the primary care doctor–patient relationship and enabling patients to receive more care from their primary care doctor can help improve the quality of patient care and reduce avoidable hospitalizations.

Background

Primary care is central to a high-functioning healthcare system and thus, there is an urgent need to preserve and strengthen primary care as well as a need for support of serious illness care services for Medicare beneficiaries.

Primary Care First addressed these needs through seamless coordinated care and accommodated a continuum of interested practices and clinicians. The model tested whether delivery of advanced primary care can reduce total cost of care, accommodating practices at multiple stages of readiness to assume accountability for patient outcomes. Primary Care First focused on advanced primary care practices ready to assume financial risk and receive performance-based payments.

Primary Care First prioritized patients by emphasizing the clinician-patient relationship. The Centers for Medicare & Medicaid Services (CMS) prioritized patient choice in the assignment of Medicare beneficiaries to Primary Care First practices.

Model Design

Primary Care First aimed to foster practitioner independence by increasing flexibility for primary care, providing participating practitioners with the freedom to innovate their care delivery approach based on their unique patient population and resources. PCF participants may have received additional revenue based on their performance on easily understood, actionable outcomes.

In Primary Care First, CMS used a focused set of clinical quality and patient experience measures to assess quality of care delivered at the practice. A PCF practice was required to meet standards that reflected quality care in order to be eligible for a positive performance-based adjustment to their primary care model payments. These measures were selected to be actionable, clinically meaningful, and aligned with CMS’s broader quality measurement strategy. Measures included a patient experience of care survey, controlling high blood pressure, diabetes hemoglobin A1c poor control, colorectal cancer screening, and advance care planning. CMS assessed quality of care based on a separate, focused set of measures that were clinically meaningful for patients with complex, chronic needs, and the serious illness population.

To amplify the impact of the model, Primary Care First was designed as a multi-payer model. Primary Care First payer partners committed to aligning with the model’s payment methodology, quality measurement strategy, and data sharing approach in order to align resources and incentives across a participating practice’s entire patient population. Payer partners included Medicare Advantage plans, commercial health insurers, State Medicaid agencies, and Medicaid managed care plans (to the extent permitted and consistent with the Medicaid managed care plan’s contract with the state).

Model Goals

Primary Care First aimed to improve quality, improve patient experience of care, and reduce expenditures. CMS believed that the model would achieve these aims by increasing patient access to advanced primary care services. PCF had elements specifically designed to support practices caring for patients with complex chronic needs or serious illness. The specific approaches to care delivery were determined by practice priorities. Practices were incentivized to deliver patient-centered care that reduced acute hospital utilization or total per capita cost. PCF was oriented around five comprehensive primary care functions:

  1. Access and continuity;
  2. Care management;
  3. Comprehensiveness and coordination;
  4. Patient and caregiver engagement; and
  5. Planned care and population health.

Primary Care First aimed to be transparent, simple, and hold practitioners accountable by:

  • Providing model payments to practices through a simple payment structure, including:
    1. A flat payment that encourages patient-centered care, and compensates practices for in-person treatment;
    2. A population-based payment to provide more flexibility in the provision of patient care along with a flat primary care visit fee; and
    3. A performance-based adjustment providing an upside of up to 50% of model payments as well as a small downside (negative 10% of model payments) incentive to reduce costs and improve quality, assessed and paid to practices on a quarterly basis.
  • Providing practice participants with performance transparency, through identifiable information on their own and other practice participants’ performance to enable and motivate continuous improvement.

Primary Care First provided the tools and incentives for practices to provide comprehensive and continuous care, with a goal of reducing patients’ complications and overutilization of higher cost settings, leading to higher quality of care and reduced spending.

Cohort 2 Eligibility Requirements

Eligible Primary Care First Cohort 2 applicants were primary care practices that:

  • Were located in one of the 26 Primary Care First regions.
  • Included primary care practitioners (MD, DO, CNS, NP, and PA) certified in internal medicine, general medicine, geriatric medicine, family medicine, and hospice and palliative medicine.
  • Provided primary care health services to a minimum of 125 attributed Medicare beneficiaries at a particular location.
  • Had primary care services account for at least 50% of the practice’s collective billing based on revenue. In the case of a multi-specialty practice, 50% of the practice’s eligible primary care practitioners’ combined revenue must come from primary care services.
  • Had experience with value-based payment arrangements or payments based on cost, quality, and/or utilization performance such as shared savings, performance-based incentive payments, and episode-based payments, and/or alternative to fee-for-service payments such as full or partial capitation.
  • Adopted and maintained, at a minimum, health IT meeting the definition of CEHRT at 42 CFR 414.1305 and the certification criteria found at 45 CFR 170.315(c)(1)-(3) for electronic clinical quality measure (eCQM) reporting, using the most recent update available on January 1 of the Measurement Period, for the eCQMs in the Primary Care First measure set; supported data exchange with other providers and health systems via Application Programming Interface (API); and connected to their regional health information exchange (HIE).
  • Attested via questions in the Practice Application to a limited set of advanced primary care delivery capabilities, such as 24/7 access to a practitioner or nurse call line and empanelment of patients to a practitioner or care team.
  • Were able to meet the requirements of the Primary Care First Participation Agreement.

Eligible practitioners were those in internal medicine, general medicine, geriatric medicine, family medicine, and/or hospice and palliative medicine. Each practice applicant was required to identify each eligible practitioner by National Provider Identifier (NPI) in its application. CMS conducted a program integrity screening on the practice and the eligible practitioners that it intended to include in PCF. CMS couldreject an application on the basis of the results of a program integrity screening. CMS noted that PCF Cohort 2 participants must meet the eligibility requirements as described in the PCF model participation agreements.

Timelines

The practice solicitation period for PCF Cohort 2 opened on March 16, 2021 and closed on May 21, 2021. The payer solicitation period for PCF Cohort 2 began on March 16, 2021, and closed on June 18, 2021.

Practice and payer selections took place in Summer or Fall 2021. Cohort 2 began participation in PCF in January 2022. CMS planned to focus on onboarding participating practices and payer partners to the model in Fall and Winter 2021.

Information for Cohort 2 Applicants (2022 Starters)

Webinars

Care Transformation Resources

Evaluation

Latest Evaluation Report

Prior Evaluation Report

Additional Information

Where Health Care Innovation is Happening