Project Overview
To determine whether medical practices participating in the Primary Care First alternative payment model improve quality and reduce costs for Medicare fee-for-service beneficiaries.
The Primary Care First model is a continuation of the Center for Medicare & Medicaid Innovation’s efforts to improve primary care in the United States and to shift from fee-for service to value-based payment.
- Mission Analytics Group
- Johns Hopkins University
U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation
Primary care is central to a high-functioning healthcare system. The Primary Care First model provides participating primary care practices with predictable population-based revenue and performance-based payments. The Centers for Medicare & Medicaid Services (CMS) hypothesizes that practices will use these payments to increase patients’ access to advanced primary care services. This, in turn, will lower hospitalization rates, improve quality of care, improve patient experiences of care, and reduce healthcare expenditures.

Findings from the Third Annual Report
- Primary Care First did not reduce acute hospitalization rates among Medicare fee-for-service beneficiaries in its first two years, and it increased Medicare expenditures by 1 percent.
- Practices that initially joined in 2021 have remained engaged in the model and reported a range of changes to their delivery of care even if Primary Care First was not their main motivating factor or funding source.
- Nearly two-thirds of practices pursuing care management strategies reported that changes were funded in part or solely by payments from Primary Care First.
- Attrition from the model has been high. In the model’s first three years, 27 percent of practices left, primarily because of concerns related to financial aspects of the model. Broader multi-payer participation and alignment with the model was also limited.
Evidence & Insights From This Project

Evaluation of the Primary Care First Model: Second Annual Report
This report presents findings from Mathematica’s independent evaluation of the second year of the Primary Care First model. The model is a continuation of CMS’ efforts to enhance primary care and move primary care practitioners toward value-based payment.
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