CMS to end key primary care payment models prematurely, citing cost and effectiveness

The Centers for Medicare & Medicaid Services (CMS) Innovation Center is shutting down several Medicare alternative payment models ahead of schedule — including two focused on primary care. The move, first reported by Axios, is part of the agency’s efforts to align CMS’s portfolio with the goals of the “Make America Healthy Again” movement.

Among the programs being cut are Primary Care First (PCF) and Making Care Primary (MCP) — both designed to test alternative payment structures for primary care providers. Other models facing early termination include the End-Stage Renal Disease Treatment Choices initiative and the Maryland Total Cost of Care model.

CMS estimates these changes will save taxpayers nearly $750 million by the time they conclude on December 31, 2025.

Shifting focus to proven cost-saving models

CMS maintains that, while these terminations mark the end of certain payment experiments, they do not signal a retreat from its commitment to primary care innovation.

“Primary care remains a foundational component of the Center’s strategy,” the agency wrote in a fact sheet released Wednesday. “This early termination of Primary Care First and Making Care Primary does not signal a retreat from the Center’s support of primary care providers, but rather a need to focus on different approaches that are consistent with the CMS Innovation Center’s statutory mandate and produce savings.”

CMS noted that its payment models are intended as time-limited experiments and that not every model yields the intended benefits. The agency emphasized the importance of ongoing evaluation.

“As is the nature of innovation, not every model will work, and the Center must be efficient and effective in its response,” the fact sheet read. “The Center regularly assesses and may amend model activities in response to a model’s projected savings, quality outcomes data, legal compliance, operational feasibility, and gaps in expected versus actual impact.”

Concerns over commitment to primary care

The PCF model, launched in 2021, aimed to shift reimbursement away from the traditional fee-for-service model, by offering performance-based payments to primary care providers. MCP, a newer initiative, was intended to support care coordination and team-based approaches.

Although CMS insists it remains committed to primary care, the decision to end these models raises concerns among health care professionals. Some industry experts argue that frequent changes to Medicare payment structures make it difficult for providers to invest in long-term practice transformation.

What’s next for participants?

CMS says it will introduce a new strategy focused on preventing disease, empowering patients with health information, and fostering choice and competition in health care markets. The agency also stated that providers affected by the cancellations will receive technical assistance and guidance to minimize disruptions.

CMS says it will work closely with participants in the affected models to minimize disruptions for both providers and beneficiaries. The agency also plans to publish final evaluation reports on the discontinued models, sharing key findings to inform future payment reform efforts.

CMS has promised continued transparency as it develops its strategic vision, evaluates modifications to existing models, and rolls out new payment innovations aimed at improving quality of care while protecting taxpayer dollars.

Mehmet Oz, MD, MBA, heart surgeon and television personality nominated to lead CMS, is scheduled to appear before the Senate Finance Committee tomorrow, March 14.