The Primary Care First Model Options announced by the Centers for Medicare & Medicaid Services (CMS) on April 22 represent an innovative, voluntary program introducing five-year payment models. These models support the delivery of advanced primary care with special emphasis on complex patients with chronic illnesses—seriously ill patients—reducing administrative burden and focusing financial rewards on improved health outcomes. Starting in 2020, this program will be offered only in 26 regions. Many of the regions are statewide, except for New York, Pennsylvania and Kansas, where specific greater urban areas have been defined. CMS’s recognition of the central role that primary care plays in a high-functioning healthcare system is not novel. The Affordable Care Act firmly established CMS’s commitment to strengthening primary care by introducing payment models that support and strengthen the primary care delivery system. The programs have evolved over the years and clearly were staged to provide a crawl, walk, run approach. The Patient Centered Medical Home (PCMH) in its early phases required a team-based approach, and a commitment to continuous improvement and the availability of health information technology (HIT) tools that supported documentation and reporting of quality measures. Comprehensive Primary Care Plus (CPC+) introduced more evolved concepts such as chronic disease management, care management and risk stratification, as well as a multipayer reporting. It is reassuring to see that the Primary Care First Model Options continue to expand and evolve these themes.