The U.S. Department of Health and Human Services on Monday announced an ambitious, double-pronged strategy to shift primary care from fee-for-service payments to a global fee model where clinicians and hospitals could assume varying amounts of risk, Modern Healthcare reported. The Centers for Medicare and Medicaid Services projects the new voluntary programs will shift at least a quarter of people in traditional Medicare out of fee-for-service payments. The first model aims at small primary-care practices, offering two options with a flat monthly fee per patient. Bonuses or penalties will depend on their ability to keep their patients healthy. Larger practices and health systems would have additional choices, which could be very lucrative but pose steeper risks. There is also a “geographic option,” in which health systems or insurance plans could assume the risk for the total cost of primary care for a swath of communities within a particular region. Most of the newly announced Innovation Center models will launch in January 2020. All five payment model options focus on supporting care for patients who have chronic conditions and serious illnesses, as outlined by HHS here.