ACO PC Flex Year 1: What We’ve Learned So Far and What Comes Next
When CMS introduced ACO Primary Care Flex (PC Flex), it promised to strengthen primary care within MSSP ACOs by offering upfront payments and greater flexibility. Year 1 of ACO Primary Care Flex is still underway, but early results highlight both promise and pitfalls. Some ACOs are leveraging new payment models to strengthen their workflows, while others are still struggling with governance and patient engagement. Now that Year 1 is behind us, the results show both promise and pitfalls. Some ACOs leveraged Flex dollars to redesign workflows, while others struggled with data, governance, and patient engagement.
At Chirpy Bird, we work closely with ACOs every day, and our team has witnessed these patterns firsthand. The good news? The lessons learned in Year 1 can lead to better results in 2026. In this post, we’ll break down five of the most important takeaways and show you how to turn them into action steps for your practice.
Lesson 1: Governance Matters
ACO leadership that established clear roles for compliance, care coordination, and financial oversight early on had fewer workflow breakdowns. In contrast, ACOs with vague accountability often saw duplication of effort and missed reporting deadlines.
Action Step: Define responsibilities now. Assign data monitoring, patient outreach, and compliance to specific roles instead of shared “everyone does it” tasks.
Lesson 2: Data Transparency Drives Performance
The ACOs that shared real-time dashboards across practices saw stronger performance. When frontline staff could track preventive care rates or chronic care control measures themselves, they were more motivated to close gaps.
Action Step: Invest in shared dashboards with clear benchmarks. Staff engagement rises when people see the direct results of their work.
Lesson 3: Patient Engagement Is Still the Bottleneck
Even with Flex payments, many practices struggled to bring patients into preventive and chronic care visits. This barrier was most pronounced in rural or resource-limited settings.
Action Step: Utilize a portion of your Flex funding for outreach campaigns, transportation solutions, or telehealth follow-ups. Engagement won’t improve without direct investment.
Lesson 4: Flexibility ≠ Free-for-All
Some ACOs assumed flexibility meant they could delay structural changes. In practice, flexibility worked best when paired with accountability checkpoints, like monthly reviews and patient-level analytics.
Action Step: Create monthly “check-ins” for progress on Flex-related initiatives. Flexibility should adapt workflows, not replace oversight.
Lesson 5: Small Wins Build Momentum
The ACOs that piloted small initiatives (e.g., HbA1c outreach or hypertension follow-ups) early in the year built momentum and avoided a Year-End scramble.
Action Step: Test one or two workflows before scaling systemwide. A small but successful initiative builds staff confidence and produces early returns.
The first year of PC Flex showed us that flexibility alone doesn’t guarantee success. It’s the combination of clear governance, transparent data, and proactive engagement strategies that separates high-performing ACOs from those still playing catch-up.
Looking ahead to 2026, ACOs should carry these lessons forward. By applying what we’re learning in Year 1, you can avoid the pitfalls, optimize resources, and position your organization for stronger performance.
👉 At Chirpy Bird, we help ACOs make sense of CMS changes and turn them into compliance wins. If your organization is navigating PC Flex or preparing for Year 2, our team is ready to support you.
Schedule a consultation today to discuss your strategy.
👉 What was your biggest lesson learned from Year 1 of PC Flex?
👉 What changes are you making heading into 2026?
Drop your thoughts below. Your feedback helps the community and gives us all better ideas for tackling Year 2 together.
