Multi-Payer Advanced Primary Care Practice (MAPCP)

Description: 

[Ended in 2016] Under this demonstration, CMS will participate in multi-payer reform initiatives that are currently being conducted by states to make advanced primary care practices more broadly available. The demonstration will evaluate whether advanced primary care practice, will (1) reduce unjustified variation in utilization and expenditures; (2) improve the safety, effectiveness, timeliness, and efficiency of health care; (3) increase the ability of beneficiaries to participate in decisions concerning their care; (4) increase the availability and delivery of care that is consistent with evidence-based guidelines in historically underserved areas; and (5) reduce unjustified variation in utilization and expenditures under the Medicare program. 

In early 2014 a decision was made to extend the demonstration in all states through the end of 2014, and in September 2014 CMS announced that it would offer six of the eight states participating in the  MAPCP demonstration the opportunity to extend the demonstration through 2016. The offer to extend the demonstration was made to those states for which some of the MAPCP Demonstration payment goes to community based organizations that could not bill independently under the Chronic Care Management (CCM) codes proposed to take effect in January, 2015. Five states (Maine, Michigan, New York, Rhode Island, Vermont) accepted the offer and will continue participation in this demonstration through 2016.

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Payment Model: 

Under this demonstration, providers will continue to receive payment for traditional Medicare fee-for-service claims in the standard manner. However, under the demonstration states will pay participating practices additional amounts for transforming their practices into medical homes and for providing services that are not otherwise covered under the traditional Medicare fee-for-service program. The amount of the payments vary by state. The form of the payment may include a monthly fee for each participating beneficiary attributed to a participating practice, pay-for-performance incentives, shared savings or some combination the above. Payment for community-based practice support may be made separately from payments to participating practices. Additionally, each participating State will have mechanisms to offer APC practices community support and linkages to State health promotion and disease prevention initiatives.

Cost Savings: 

RTI International (January 2015) independent evaluation prepared for CMS

  • The MAPCP Demonstration generated an estimated $4.2 million in savings in its first year through the use of advanced primary care initiatives
  • The rate of growth in Medicare FFS health care expenditures was reduced in Vermont and Michigan, driven largely by reduced growth in inpatient expenditures
Last updated August 2018
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