Primary Care MATTERS
A national initiative examining how CMS payment policy changes are affecting the willingness of primary care physicians to participate in Medicare value-based care.
This site provides information on the Retrospective Trend Adjustment (RTA) risk corridors and documents, feedback from primary care providers across the country on how these policies are influencing financial stability, practice planning, and decisions about continued participation in Medicare ACO models, including ACO LEAD. Survey results reflect growing concern among primary care providers about the sustainability of value-based care under current policy design.
When asked
"If CMS does not address the current RTA risk corridor structure, how would this influence your likelihood of participating in future CMS value-based care programs, including LEAD?”
reported that the current approach to RTA risk corridors would significantly reduce or eliminate their willingness to participate in CMS value-based care programs like ACOs moving forward.
(survey data updated daily)
How Risk Corridors Affect Primary Care
Primary care ACOs deliver measurable Medicare savings
Primary care–led ACOs have consistently reduced total cost of care while meeting quality standards. In 2023 alone, Medicare ACOs generated more than $2 billion in gross savings, demonstrating that value-based primary care can lower costs while improving outcomes.
Practices that meet performance and quality benchmarks earn a portion of these savings, which are typically reinvested in care teams, patient outreach, and clinical infrastructure not supported under fee-for-service Medicare.
Shared savings fund value-based care
Shared savings are the financial foundation of value-based care. They support staffing models, care coordination, and investments that help keep Medicare patients out of the hospital.
When shared savings are reduced or revised after performance periods end, practices face difficult decisions about sustaining these capabilities.
RTA risk corridors introduce retrospective uncertainty
Retrospective Trend Adjustment (RTA) risk corridors reconcile forecasting error after care has already been delivered. While intended to account for unexpected cost trends, retrospective adjustments can materially lower benchmarks after the fact, creating financial uncertainty for participating practices.
CMS is clawing back earned shared savings
In recent years, national healthcare costs exceeded CMS projections. For 2025, underprediction has been estimated at approximately 10%, resulting in more than $1 billion in reduced shared savings across Medicare ACOs.
For many primary care practices, this level of retrospective adjustment undermines financial predictability and complicates long-term participation decisions.
What This Means for Medicare Value-Based Care
Value-based care depends on primary care physicians choosing to participate and remain engaged over time. That choice requires alignment between performance, effort, and predictable outcomes.
When shared savings are adjusted retrospectively, the connection between performance and reward weakens. Practices may deliver high-quality, lower-cost care, yet remain uncertain about financial results until well after the performance period ends.
Over time, this uncertainty affects motivation. Participation decisions increasingly reflect risk tolerance rather than clinical performance. For many practices, especially smaller or independent groups, this dynamic influences whether they remain in ACOs, limit future participation, or opt out of value-based care models altogether.
This initiative exists to document how primary care physicians are weighing those decisions.
“This site is operated by a healthcare organization conducting research on primary care participation in value-based care.”