Primary Care First Model Evaluation of the First Year (2021): Findings at a Glance

The 2021 launch of the Primary Care First (PCF) model by the Centers for Medicare & Medicaid Services (CMS) Innovation Center is a continuation of efforts from several previous models that aims to enhance primary care in the United States and to move primary care practitioners from fee- for-service (FFS) toward value-based payment. The goals of the PCF model are to improve care for Medicare FFS beneficiaries and to lower costs for CMS, with an emphasis on patients’ outcomes over care delivery requirements.

Mathematica has completed year one of its evaluation of the model, focusing on advanced primary care attributes that Cohort 1 practices report they possessed at the start of PCF and the approaches these practices have taken or plan to take to change how they deliver advanced primary care. The evaluation team focused on the strategies PCF practices undertook to reduce hospitalizations or lower costs, with an emphasis on identifying whether any of these strategies were new to the practices since joining PCF.

Results from the study show that practices entered the model with advanced care capabilities and their care delivery changes in 2021 were largely enhancements of existing activities. Estimated PCF payments were generous, averaging about 20 percent higher than practices would have received under the Medicare physician fee schedule.