Here's an introductory article with some links.
On January 1, 2025, the Centers for Medicare & Medicaid Services (CMS) introduced the Advanced Primary Care Management (APCM) program. This article provides an introductory look at this new program, and encourages our readers to learn more about it … through the NaCCRA forums and other sources
https://www.lara.health/post/debating-the-pros-and-cons-of-the-newly-announced-advanced-primary-care-management-apcm-services-for-2025
https://www.medicaleconomics.com/view/remote-patient-monitoring-in-2025-the-major-changes-physicians-need-to-know-about
https://www.ama-assn.org/system/files/ama-2025-mpfs-summary.pdf
APCM - What Is It?
The APCM program offers providers a fixed monthly payment for managing the primary care of patients with chronic conditions, based on the complexity of each patient’s overall condition. The program is part of Medicare’s broader move toward “value-based” care, such as HMO-type medicine and Medicare Advantage, focusing more on health outcomes and less on specific services and tasks. APCM seeks to improve primary care and deals only with primary care. It simplifies tracking and billing processes and emphasizes comprehensive, patient-centered services. The rationale is that providers can spend more time delivering personal, high-quality service and less time doing paperwork. At our senior community in Maryland, the program was announced in May and described as a major improvement in the medical services reimbursement model.
How Does It Work?
APCM consolidates existing primary care management services into a single monthly payment and does not require tracking the exact time spent on services. Eligible providers include physicians, nurse practitioners, physician assistants, and clinical nurse specialists. Providers bill CMS monthly using one of three new complexity levels (Low, Moderate, or High), determined by the provider using a new protocol. Patients enrolled in APCM can revoke consent at any time and may choose any provider who participates in APCM.
Providers must:
· Take full responsibility for (provide all of) the patient’s primary care
· Obtain the patient’s informed consent for enrollment
· Deliver ongoing, coordinated care that meets CMS’s service requirements.
Analysis and Context
APCM-enrolled patients remain in traditional Medicare but receive their primary care through APCM. Thus, our current understanding is that, if they need specialist services or hospitalization, those services are handled on a fee-for-service basis as in the past.
APCM provides a simplified payment structure that encourages comprehensive, coordinated primary care without the complexities of full capitation or managed care arrangements. It shares the broad value-based care objective of Medicare Advantage but maintains the traditional Medicare framework for its patient enrollees requiring specialized or advanced treatments. It offers medical providers more flexibility and simpler reporting without the constraints of managed care networks. APCM represents a strategic shift in Medicare's approach to primary care, emphasizing comprehensive, pro-active, patient-centered services and simplified, monthly bundled payments.
APCM seeks to preserve patient choice to remain in traditional fee-for-service Medicare for their specialized or advanced care, and to emphasize care coordination, ongoing monitoring and support, and proactive care management for their chronic conditions. Thus in some ways, it is a “middle ground” between “Traditional Medicare” and “Medicare Advantage”.
The Bigger Picture
In general, for our society, and especially for seniors, managing medical costs, now and in the future, is one of the major challenges confronting us. It is a very complex picture. For some time, Medicare has been migrating toward “Managed Care” and “Value-Based Care” as a general strategy. Like any strategy that addresses a complex challenge, this approach has advantages and risks, and our volunteers are actively monitoring developments, especially as they impact seniors living in managed communities. APCM is a brand-new health services program, so only time will tell how it will work.
Talk to Us …
As an association of seniors living in managed communities, NaCCRA has a major ongoing interest in this area. In this article, our purpose is to alert you about a new payment model option you may be offered by your primary care provider. We want to learn from our readers what their experiences as this program rolls out. If you have news or questions, please post in this APCM thread on the General forum, or on one of the other forums, or send an email to info@naccra.com. We will continue to monitor developments in this area and we will provide future articles and notes as events warrant.