Primary care physicians who were trying to transition out of a fee-for-service world sometimes were hit with up-front costs that made it more difficult to get excited about altering their care model in a significant way.

The framework for the Centers for Medicare & Medicaid Services' new Comprehensive Primary Care Plus Model reduces some of that problem by paying an incentive fee at the beginning of the program instead of the end. If the incentive is not earned, the funds are pulled back later in the program, according to a fact sheet from the Center for Medicare & Medicaid Innovation.

“One of the running critiques we’ve had about some of these models is that it takes a substantial up-front investment by providers to be able to participate, in terms of infrastructure and implementing care management,” says Melissa Jackson, senior associate director of policy development for the American Hospital Association. "It is good that CMMI has acknowledged that," Jackson says.

Jackson also says that the model's approach of working with health care payers to gain commitments for participation is a positive. The model will be offered in regions that CMS officials believe can be supported by the payers operating there.

The model, an expanded version of an initiative launched in 2012, includes two tracks — a basic track that relies largely on fee-for-service reimbursement coupled with care management and incentive fees plus a more advanced version that will get reimbursed using a hybrid model.

The AHA is still studying the model, and hasn't reached a broad conclusion on its potential effectiveness.

The same holds true for the American Medical Association, which released a statement from Steven Stack, M.D., president. “At first glance, this new payment model initiative includes several advances over the current primary care model, particularly because it emphasizes improvements in care that are achievable by primary care physicians instead of cost reductions that are beyond their control, Stack said in the statement. “We look forward to reviewing the proposal in detail and working constructively with CMS to ensure that physicians have flexible and workable payment models that support high-quality patient care and put less administrative burden on physician practices to alleviate physician burnout."