Paying docs to manage care shows promise—but the pay is about to drop

The CMS Innovation Center’s massive Comprehensive Primary Care initiativeappeared to break even its first year, but there is concern that a planned reduction in its care-management fee this year could impede the fragile momentum it has built.

The program was launched in October 2012 with 502 participating practices supported by Medicare and 31 other insurance plans based in seven regional areas. 

An evaluation of the initiative's first year (PDF) found practices received $141.3 million from per-member per-month care-management fees, and that—as of December 2013—492 practices were still engaged in the effort as were 29 of the original payers. The initiative, which runs through 2017, seeks to test the clinical benefits and financial sustainability of medical-home practices that provide enhanced patient access and continuity of care, planned chronic and preventive care, risk-stratified care management, patient and caregiver engagement, and coordination of care across a “medical neighborhood.”

Approximately 2.5 million patients were cared for in the program’s first year, with Medicare contributing $90.5 million in care-management fees toward the effort. Early calculations suggest a 2% monthly savings in Part A and Part B fee-for-service expenditures, according to the report, which was written by a team fromPrinceton, N.J.-based Mathematica Policy Research and Group Health Research Institute in Seattle.

Go to top