How primary care transformation gets funded has shifted sharply. This lesson covers the current landscape and where the support now comes from.
Practices pursuing transformation reasonably ask who will pay for it. The answer has changed recently and sharply, so this lesson covers the current landscape rather than the one that existed a few years ago.
The recognition programs
The longest-standing route is patient-centered medical home (PCMH) recognition, offered by accrediting bodies and tied in many states and contracts to enhanced payment. Recognition programs codify the functions from the previous lesson and give payers a standard to pay against. They remain widely used, with the caveat about checklist compliance already noted.
The federal model landscape has narrowed
For years, CMMI ran a series of dedicated primary care demonstrations. That era has contracted:
Worth remembering: in 2025 CMS terminated several models early, including Primary Care First and Making Care Primary (which ended June 30, 2025), as part of a deliberate portfolio reset toward models with clearer savings logic. Practices should not plan around the standalone primary care demonstrations of the recent past. Federal support for primary care transformation is increasingly delivered through accountable care models rather than dedicated primary-care demos.
The Innovation Center has kept primary care and accountable care as its stated foundation while consolidating the vehicles. The successor ACO model, LEAD, is explicitly designed to draw in smaller, rural, and high-needs-serving clinicians with predictable benchmarks and flexible payments, which is a primary care transformation strategy delivered through an ACO chassis.
Where the funding actually comes from now
Practically, a transforming practice today draws support from several places:
| Source | What it provides |
|---|---|
| Accountable care participation | Shared savings and, in some models, flexible primary care payments |
| Commercial and Medicaid contracts | Care management fees, PCMH payments, VBP incentives |
| Medicare fee schedule codes | Payment for care management, behavioral health integration, and similar services |
| Recognition-linked payments | Enhanced rates tied to PCMH or similar status |
The strategic read
The narrowing of dedicated federal models makes the case for accountable care participation stronger, not weaker: it is now the main federal route through which primary care transformation is funded. And the volatility itself is a lesson, echoing the policy course: models come and go, so a practice should build capabilities that pay off across payers and models rather than optimizing for a single demonstration that may end.
Key takeaways
- PCMH recognition remains a durable route, tied to enhanced payment in many contracts.
- CMS terminated Primary Care First and Making Care Primary in 2025, shifting federal support toward accountable care models rather than standalone primary care demos.
- Build capabilities that pay off across payers and models; individual models are volatile, but the underlying functions are consistently rewarded.
Sources
Check your understanding
What happened to the CMS Innovation Center's standalone primary care models in 2025?
In 2025 CMS ended Primary Care First and Making Care Primary early as part of a portfolio reset, shifting primary care support increasingly into accountable care models rather than standalone primary-care demonstrations.