Why Elation Supports the Patients First Act

Medicare pays for visits. It doesn’t pay for the phone call that prevented the ER trip, the care manager keeping a diabetic patient on track, or the follow-up that caught something upstream of catastrophe. The Patients First Act of 2026 is trying to change that. Elation supports it as a vital step in the right direction for payment reform.

That’s why Elation provided feedback on and declared its support for a letter from the Primary Care Collaborative (PCC) and its Better Health–NOW campaign backing the Patients First Act. The letter also responds to the bill sponsors’ questions about how to fund and strengthen Medicare physician payment reform.

Why Primary Care Payment Reform Matters 

Fee-for-service can make it difficult for practices to invest in the care that keeps patients healthier over time. A visit is easy to count. A phone call that prevents an emergency department visit, a care manager helping a patient stay on track, or a team coordinating with a specialist is harder to capture. Over time, that mismatch puts pressure on practices and makes it harder to sustain the kind of continuous, whole-person care patients need.

That is the problem H.R. 9693 is trying to address. The introduced bill text would create a five-year hybrid payment demonstration for primary care. Practices would receive a prospective per-member-per-month payment for a defined bundle of services while continuing to bill fee-for-service for other care.

The basic idea is simple: pay primary care practices for more of the work they already do. A more predictable payment could give practices room to build care teams, provide follow-up between visits, and invest in prevention and care management. The PCC has also outlined how hybrid payments can make primary care more patient-centered.

Patients could benefit as well. The bill would eliminate cost-sharing for the primary care per-member-per-month bundle during the demonstration. Removing that barrier could make it easier for Medicare beneficiaries to seek preventive care and use care management or behavioral health services before a manageable concern becomes more serious. That matters as chronic physical and mental health conditions continue to affect more people.

Designing a Model That Works for Primary Care

But payment reform is not just about creating a new model on paper. The details will determine whether the pilot produces useful results and reaches the patients who need primary care most.

The PCC letter raises concerns about eligibility limits that could exclude people who are dually eligible for Medicare and Medicaid, along with practices in academic medical centers, community health centers, safety-net settings, and independent practices. If those patients and practices are left out, the pilot may not tell us how hybrid payment works for people with the most complex needs. Congress should also review the definition of an “excluded practice” so physician-led independent practices, including those that participate in accountable care organizations, are not shut out by mistake.

Behavioral health services need the same level of clarity. The bill should specify which services would be included in the prospective payment and which would remain separately billable at their full value. Clear rules would help practices plan their teams and services, while making it easier to evaluate the pilot’s effect on access, outcomes, and total cost of care.

At this stage, H.R. 9693 is an introduced bill, not enacted law. Any final model would depend on what Congress ultimately passes and how the relevant agencies implement it. Still, the proposal moves the conversation in a direction primary care needs: toward payment that recognizes relationships, coordination, prevention, and care between visits.

That goal aligns with the way Elation supports value-based care through population health management, quality reporting, and patient engagement workflows. Technology cannot fix an inadequate payment model on its own, but it can help practices make the most of a model that supports comprehensive care.

As the bill moves forward, physicians, patients, practices, and communities should have a voice in the details. Their input will help determine whether the model improves access, supports clinical teams, and delivers value for Medicare. Primary care needs a payment system that reflects the care teams provide every day. The Patients First Act is one proposal that could move Medicare in that direction, and it is a conversation we are glad to support.

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Elation’s primary care EHR helps practices coordinate care, support clinical teams, and stay focused on their patients. Explore how Elation can support the work that happens before, during, and after every visit.