CMS Comprehensive Primary Care Initiative

Description: 

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 choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients. 

The CPC initiative offers a way to break through this historical impasse by inviting payers to join with Medicare in investing in primary care in 7 selected localities across the country. Eligible practices in each market were invited to apply to participate and start delivering enhanced health care services in the fall of 2012. Practices were selected through a competitive application process based on their use of health information technology, ability to demonstrate recognition of advanced primary care delivery by accreditation bodies, service to patients covered by participating payers, participation in practice transformation and improvement activities, and diversity of geography, practice size and ownership structure.

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: 

CMS Blog (October 2015) results from first shared savings performance year (2014)

  • All regions had lower-than-targeted hospital readmission rates.
  • Lower readmissions indicate better coordination of care during transitions and patient support during the post-discharge period.

Mathematica Policy Research (January 2015) independent evaluation prepared for CMS

  • "CPC generated reductions in hospitalizations, outpatient ED visits, primary care physician visits, and specialist visits," however evaluators recommend that these findings be interpreted with caution 
  • 2% reduction in hospital admissions and 3% reduction in ED visits, contributing to the reduction of expenditures nearly enough to offset care management fees paid by CMS
  • There was a sizable (4 percent) CPC-wide decline (that was not quite statistically significant) in unplanned 30-day readmissions
Improved Health: 

CMS Blog (October 2015) results from first shared savings performance year (2014)

  • Over 90% of CPC practices successfully met quality targets on patient experience (as determined by CAHPS surveys) and utilization (hospital admission and readmission) measures, indicating quality scores that matched or exceeded national comparisons
Improved Access: 

CMS (November 2014) summary of practice reports from July 2014 for the second quarter of 2014, which spanned the period from April through June 2014​ 

  • 99 percent of practices offer patients around-the-clock access to a care team member with real-time access to the EHR (2014)
Cost Savings: 

Mathematica Policy Research (April 2016) independent evaluation prepared for CMS evaluating Year 2 of the program's implementation

  • CPC has not generated savings net of care management fees
    • The change in average expenditures including the care management fees was $7 higher for CPC than comparison beneficiaries (p = 0.27, 90 percent CI -$3, $17)
  • CPC reduced average monthly Medicare expenditures without care management fees by $11 per beneficiary per month (PBPM), or 1 percent (p = 0.074), over the initiative’s first two years, with the 90 percent confidence interval ranging from a reduction of $1 to $21.
  • Based on the total number of eligible beneficiary months among beneficiaries attributed to CPC practices in the first two years, the impact estimate of $11 per beneficiary per month translates to an estimated cumulative savings in Medicare expenditures without fees of $91.6 million. 
  •  3 percent reduction in primary care visits (p < 0.01) contributed minimally to savings​

 

CMS Blog (October 2015) results from first shared savings performance year (2014)

  • The CPC initiative generated a total of $24 million in gross savings overall (excluding the CPC care management fees)
  • Arkansas, Colorado, Cincinnati-Dayton region of Ohio, and Oregon generated gross savings
  • The Greater Tulsa region generated net savings of $10.8 million and earning more than $500,000 in shared savings payments

Mathematica Policy Research (January 2015) independent evaluation prepared for CMS

  • Across all seven regions in the first year, early results suggest that CPC has generated enough savings in Medicare health care expenditures to nearly cover the CPC care management fees paid by CMS for attributed Medicare FFS beneficiaries, although not enough to generate net savings
  • The bulk of the savings was generated by patients in the highest-risk quartile, but favorable results were also seen in other patients
  • Across the seven regions, CPC reduced Medicare Part A and Part B expenditures per beneficiary by $14 or 2%
    • These reductions are relative to a matched comparison group and do not include the care management fees (~$20 per beneficiary per month)
Other Outcomes: 

Mathematica Policy Research (January 2015) independent evaluation prepared for CMS

  • Over 90 percent of practices successfully met all first-year transformation requirements

CMS (November 2014) summary of practice reports from July 2014 for the second quarter of 2014, which spanned the period from April through June 2014​  

  • Although not required by the CPC initiative, 65 percent of practices reported having employed behavioral health specialists.
  • 84 percent of participating practices were using 2014-certified technology by the end of June 2014, and 93 percent could exchange health information electronically with at least one other care setting, such as an acute care hospital, a pharmacy or another physician office.
Last updated April 2016
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