While the healthcare industry braces for potential cuts to Medicaid and Medicare Advantage due to regulation like the Big Beautiful Bill (BBB), there's a silver lining that many primary care providers (PCPs) are missing, incentives to transition to value-based care (VBC). I wanted to understand more about these programs to think through how vendors like NeuroFlow or Ilant Health might take advantage of them. I hope this is helpful to others as well.
After more than a decade of pilots and iterations, CMS has finally created two programs (both for traditional Medicare) that could be impactful for smaller practices: Making Care Primary (MCP) and ACO Primary Care FLEX. Here's why PCPs should pay attention—and how to get started.
The Programs That Actually Work for Small Practices
Making Care Primary (MCP) - CMS's new 10-year flagship model
- Direct payments of $25-40 per patient per month to practices, paid at the beginning of each month
- For a 1,000-patient Medicare panel: $300K-480K annually
- No ACO required—perfect for independent practices
- Gradual ramp into risk-based contracts
ACO Primary Care FLEX - Add-on for existing Medicare ACOs
- $15-25 PBPM for qualifying low-revenue practices
- $180K-300K annually for 1,000 Medicare patients
- Focuses on practice transformation within ACO structure
Where to Invest These Dollars for Maximum Impact
CMS explicitly encourages spending on:
🧠 Behavioral Health Integration - The biggest cost multiplier across all conditions
(Great news for a vendor like NeuroFlow)
- Collaborative care models
- On-site mental health clinicians
- Substance use disorder screening
🏠 Health-Related Social Needs
- Community health workers
- Transportation coordination
- Housing and food security partnerships
📱 Remote Patient Monitoring
- Cardiac, respiratory, and metabolic monitoring
- Chronic disease management
- Post-discharge follow-up
👥 Enhanced Staffing
- Care coordinators
- Population health nurses
- Data analysts
A Strategic Roadmap for PCPs
Phase 1: Quick Wins (Low resource, fast ROI)
- Close preventive care gaps
- Standardize hypertension/diabetes protocols
- Risk-stratify your patient panels
Phase 2: Build Infrastructure (Moderate investment)
- Hire care coordinators
- Implement behavioral health screening
- Launch telehealth for follow-ups
Phase 3: Advanced Integration (Higher investment)
- Full behavioral health integration
- Comprehensive remote monitoring programs
- Social determinants interventions
The Technology Enablement Opportunity
For healthcare IT companies, this represents a massive market opportunity. The dollars don’t go far if programs rely on staffing alone. PCPs will need:
- Patient engagement and registry solutions like DocResponse
- Analytics platforms for population health like HealthEC
- Remote monitoring technologies such as Caption Care & NeuroTrack
- Care navigation & other wrap-around services like Ilant Health, Sylvan Health
- Behavioral health integration tools like NeuroFlow
The key is understanding that these practices need turnkey solutions—not just software, but services and support to transform their care delivery models.
Why This Time is Different
Unlike previous pilots like CPC+ (which NeuroFlow supported at Thomas Jefferson University Hospital back in 2019) that were too complex or aggressive for smaller practices, MCP and FLEX are designed with accessibility in mind. They provide:
- Upfront cash flow for transformation
- Multi-payer alignment reducing fragmented incentives
- Gradual risk progression
- Direct support for practice-level changes
So, Now What?
While the broader healthcare landscape faces uncertainty, primary care providers have a clear path forward. The question isn't whether to embrace value-based care—it's how quickly you can get started.
For PCPs: The infrastructure investment made today with these dollars will position practices for success regardless of what happens with traditional fee-for-service models.
For healthcare technology companies: The practices entering these programs will need partners who understand both the clinical and business transformation required.
Despite some short-term challenges for value-based care, especially due to the BBB, these programs are worth looking at to drive investment.