On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) rolled out the Primary Cares Initiative, a collection of voluntary payment model options in support of high value primary care.1 The first element of the initiative, Primary Care First, is to engage advanced primary care practice sites via two performance-based payment model options.1 The second element of the initiative, Direct Contracting, aims to involve larger primary care entities via three risk-assuming payment model options.