Oklahoma Comprehensive Primary Care Initiative
Program Location:
Tulsa, OK
Number of Practices:
68
Payer Type:
Multi-Payer
Partner Organizations:
MyHealth Access Network
Parent Program:
Payers:
Blue Cross Blue Shield of Oklahoma
CommunityCare
Oklahoma Health Care Authority (OHCA)
Medicaid
Medicare
Reported Outcomes
Description:
The Tulsa area is one of seven regions selected for the Comprehensive Primary Care Initiative (CPC), which is an effort by the federal Centers for Medicare and Medicaid Services (CMS) to improve primary care in the country. The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients.
Primary care practices that participate in this initiative will be given resources to better coordinate primary care for their Medicare patients. Three Oklahoma payers are involved in this initiative: Blue Cross Blue Shield of Oklahoma, CommunityCare, and Oklahoma Health Care Authority (OHCA). MyHealth Access Network, an extensive coalition of health care organizations throughout Oklahoma, is serving as the convener of the CPC initiative by supporting implementation and data management for the primary care practices selected to participate.
Related News & Resources
Payment Model:
Under the Comprehensive Primary Care Initiative, CMS will pay primary care providers for improved and comprehensive care management, and after two years offer them the chance to share in any savings they generate. CMS will look to collaborate with other payers in local markets who will commit to similar changes to how they engage primary care practices.
- Monthly Care Management Fees for Medicare Fee-for-Service Beneficiaries: CMS will pay participating practices a risk adjusted, monthly care management fee for their Medicare Fee-for-Service beneficiaries. For the first two years of the initiative, the per-beneficiary, per-month (PBPM) amount will average out to $20; for years 3 and 4, the PBPM will be reduced to an average of $15.
- Shared Savings in Medicare Fee-for-Service: After two years, all practices participating in this initiative will have the opportunity to share in a portion of the total Medicare savings in their market.
Fewer ED / Hospital Visits:
Mathematica Evaluation (January 2015) Independent evaluation of first program year prepared for CMS
"Among all patients in Oklahoma, there were three statistically significant declines per 1,000 patients in utilization:"
- Annual hospitalizations declined by 24 (7 percent)
- Annual outpatient ED visits declined by 37 (7 percent)
- Total annual ED visits fell by 41 (5 percent)
"Among high-risk patients in Oklahoma, for the CPC group relative to the comparison group, there was a statistically significant decline in four measures per 1,000 patients:"
- Annual decline in hospitalizations of 60 (8 percent)
- Annual decline in outpatient ED visits of 132 (13 percent)
- Annual decline in total ED visits of 146 (10 percent)
- Annual decline in specialist visits in all settings of 1,077 (6 percent)
Cost Savings:
CMS Blog (October 2015) results from first shared savings performance year
- The Greater Tulsa region decreased costs in excess of the CPC care management fees, generating net savings of $10.8 million and earning more than $500,000 in shared savings payments.
Mathematica Evaluation (January 2015) Independent evaluation of first program year prepared for CMS
- Oklahoma had the largest reductions in Medicare expenditures and service use among the CPC regions
- 7% decline ($59) in average monthly Medicare expenditures (without care management fees) among all patients; 5% decline ($41) in average monthly Medicare expenditures with fees, which suggests that CPC generated savings during the first year
- 12% ($36) reduction in average monthly expenditures on inpatient services
- 21% reduction ($12)in average monthly expenditures on skilled nursing facilities
- 5% ($4) reduction in average monthly expenditures on home health services
Other Outcomes:
"Among all patients in Oklahoma, there were several statistically significant findings, and most of them were unfavorable. Specifically, the CPC group relative to the comparison group, the likelihood of:"
- Receiving an eye exam for diabetes decreased by 4 percentage points (6 percent).
- Receiving all four tests for diabetes declined by 6 percentage points (21 percent).
- Receiving lipid testing for IVD increased by 2 percentage points (4 percent).
"Among high-risk patients in Oklahoma, for the CPC group relative to the comparison group, the likelihood of:"
- Receiving all four tests for diabetes declined by 4 percentage points (15 percent).
- Having a 14-day follow-up visit after a hospitalization declined by 2 percentage points (4 percent).
- Having an unplanned 30-day readmission declined by 2 percentage points (11 percent).
Last updated October 2015
