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The ACA provided incentives for physicians and other providers to join together to form ACOs, which allow physicians and other providers to better coordinate patient care and improve health care quality, help prevent disease and illness, and reduce unnecessary hospital admissions. When an ACO provides high‐quality care while reducing costs to the health care system, rules allow the ACO to keep some of the money saved. Key stakeholder groups, including nursing, engaged in public comments in response to controversial ACO rules proposed by CMS prior to the establishment of most of the ACOs currently in existence. Although ACOs clearly would benefit from the services of registered nurses (RNs), advanced practice registered nurses (APRNs), and other clinicians, certain exclusions in the rules minimize the impact of such groups in recognizing their contributions or sharing cost savings.

While most programs within the ACOs are still difficult for APRNs to participate in effectively, the Primary Care First Model Options is a set of voluntary five‐year payment options that reward value and quality by offering an innovative payment structure to support delivery of advanced primary care. In response to input from primary care clinician stakeholders, Primary Care First prioritizes the doctor–patient relationship: enhancing care for patients with complex chronic needs and high need as well as for seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes (https://innovation.cms.gov/innovation‐models/primary‐care‐first‐model‐options).

Primary Care First Model Options will begin in 2021 in 26 states. Practices will be incentivized to deliver patient‐centered care that reduces acute hospital utilization. Primary Care First is oriented around comprehensive primary care functions: (a) access and continuity; (b) care management; (c) comprehensiveness and coordination; (d) patient and caregiver engagement; and (e) planned care and population health. Eligible providers must meet numerous qualifications, including being primary care practitioners (MD, DO, CNS, NP, and PA), certified in internal medicine, general medicine, geriatric medicine, family medicine, and hospice and palliative medicine; providing primary care health services to a minimum of 125 attributed Medicare beneficiaries at a particular location; and having primary care services that account for at least 70% of the practice's collective billing based on revenue.