The Role of Medicare Alternative Payment Models in Supporting the Essential Features of Primary Care

The Centers for Medicare & Medicaid Services (CMS) has launched multiple alternative payment models (APMs) to address limitations with fee-for-service payments in traditional Medicare (TM), including challenges of TM in supporting high-quality primary care.

Using Medicare claims, CMS data on APM participation, and publicly available data, we examined the association between primary care physician (PCP) participation in TM APMs between 2017 and 2022 and the essential primary care features of accessibility, comprehensiveness, continuity, and coordination.

38.1% of PCPs in our analysis participated in at least 1 of 14 APMs during the study period. Based on a difference-in-differences analysis, we found that participation in APMs was significantly associated with improved outcomes on various key primary care dimensions. Of TM APMs assessed, hybrid payment models with no financial risk showed a significant association with improvement in all measures of the 4 essential features of primary care, both on measures that passed the parallel trends test as well as those that did not.

Overall participation in APMs is significantly associated with improved PCP outcomes on measures of various essential features of primary care. Of TM APMs assessed, only hybrid payment models with no financial risk showed a significant association with PCP improvement on all essential features of primary care. While methodological limitations preclude asserting a causal relationship, these findings support continued efforts to improve primary care for Medicare beneficiaries through hybrid payments to practices without imposing downside financial risk on PCPs.