Making care primary: a renewed investment into primary care

The Making Care Primary (MCP) model represents a sharp shift in Medicare's approach to primary care, yet its current design risks duplicating failures from prior alternative payment models. Our editorial suggests refinements to address these gaps. To prevent early provider dropout from MCP's rigid track-based system, we propose a sliding-scale infrastructure payment model that adjusts based on practice needs rather than abrupt phase-outs. Given MCP's reliance on community-based organisations (CBOs) for social determinants of health interventions, we also advocate for direct, outcomes-based contracts between providers and CBOs, ensuring accountability for patient outcomes rather than passive referrals. We recommend that MCP enforce data-sharing mandates for commercial insurers and Medicaid agencies, drawing from Washington State's successful Multi-Payer Collaborative, to avoid payer disengagement that plagued previous multi-payer models. To expand beyond conventional quality measures, we propose integrating patient-centred outcomes from the International Consortium for Health Outcomes Measurement, making sure MCP captures meaningful clinical impact. Finally, we propose programme adjustments frequently at two- to three-year intervals to refine risk adjustment methodologies. These approaches could enhance MCP's sustainability, preventing the financial instability and misaligned incentives that undermined past value-based care initiatives.