Primary Care First & Making Care Primary Are Ending— What’s Next?
In a significant shift for value-based primary care, CMS recently announced the sunsetting of two of its flagship models: Primary Care First (PCF) and Making Care Primary (MCP). These models were designed to transform primary care delivery by moving away from fee-for-service payment structures and toward value-based care that rewards outcomes over volume. Now, with both models winding down earlier than expected, providers and payers are left wondering—what’s next?
A Quick Recap: What Were PCF and MCP?
Primary Care First (PCF) launched in 2021 as a voluntary five-year model to simplify primary care payments and incentivize performance. It emphasized reduced hospitalizations, improved access, and lower total cost of care, offering capitated payments alongside performance-based bonuses and penalties.
Making Care Primary (MCP) was announced in 2023 and intended to build on lessons from PCF. It aimed to support practices—especially small and rural ones—through a three-track progression to value-based care, emphasizing team-based, whole-person care.
Both models were part of CMS’s broader strategy to move toward accountable, person-centered care under the CMS Innovation Center’s 2030 goal: 100% of Medicare beneficiaries in a care relationship with accountability for quality and total cost of care.
Why Are These Models Ending?
CMS cited a range of challenges:
Operational complexity and administrative burden for providers.
Limited uptake, especially among smaller or independent practices.
Overlapping models and misalignment with other federal and commercial value-based initiatives.
Need for greater equity and integration across payers and populations.
While both PCF and MCP had noble goals, the reality of implementation proved more difficult than anticipated. Early feedback revealed that providers found the financial benchmarks and performance metrics confusing and burdensome, and that the support for care transformation wasn’t always sufficient.
So, What’s Next?
Even as CMS ends these specific models, the agency is not abandoning value-based primary care. Instead, the focus is shifting toward more streamlined, scalable, and equitable models that reflect real-world feedback. Here’s what we know so far:
Integration into ACOs and Larger Models
CMS has signaled it will focus on Accountable Care Organizations (ACOs) as a key pathway for primary care transformation. This includes models like ACO REACH, which combine population-based payment with flexibility for care delivery innovation.
Expect primary care practices to be encouraged to join ACOs or larger networks, rather than participate in standalone models like PCF.
Convergence Across Payers
A major lesson from PCF and MCP is that alignment with commercial payers and Medicaid is essential. CMS is expected to continue pushing for multi-payer alignment, potentially through state-based innovation models or public-private partnerships.
A Focus on Equity
Future primary care models will likely embed health equity more deeply—not just as a reporting metric, but as a driver of payment and care redesign. That means more support for underserved providers, enhanced data use, and accountability for reducing disparities.
Simplification and Support
CMS has acknowledged the need to reduce administrative burden, make performance metrics more meaningful, and offer better technical assistance to small practices. Look for future models to offer clearer incentives, more user-friendly reporting, and improved infrastructure support.
What Should Providers and Payers Do Now?
Track upcoming CMS Innovation Center updates. New models are expected to be announced in 2025.
Assess your readiness for ACO participation—particularly in models like ACO REACH or MSSP that emphasize primary care leadership.
Invest in data and care management infrastructure. Future models will demand capabilities in risk stratification, social needs screening, and team-based care coordination.
Engage in multi-payer initiatives. Look to your state or region for aligned efforts across Medicare, Medicaid, and commercial payers.
Final Thoughts
While the end of Primary Care First and Making Care Primary may feel like a setback, it’s better understood as a pivot—a sign that CMS is listening, learning, and evolving. The future of primary care will still be value-based, but the next wave of models will need to be simpler, more flexible, and more inclusive.
As CMS reshapes its primary care strategy, providers and payers have a vital opportunity to help design and champion models that work—for clinicians, patients, and communities alike.
ForeSee Medical is a purpose-built software platform that helps healthcare organizations thrive in CMS value-based care models, including Medicare Advantage. Powered by proprietary medical algorithms and advanced natural language processing, ForeSee uses AI to enhance HCC coding accuracy and optimize risk adjustment—enabling providers to drive better outcomes and financial performance.
Blog by: The ForeSee Medical Team