Major Medicare Primary Care Project Announces Early Success

The Centers for Medicare & Medicaid Services announced that one of its advanced primary care projects had produced significant progress.  In only its second year, the Comprehensive Primary Care initiative had virtually achieved almost all of its goals among a pool of 481 participating practices. The Comprehensive Primary Care initiative is a four year project with the goal of improved primary care at lower cost.  Conducted by the Centers for Medicare & Medicaid Services, the CPC initiative involved 481 practices in seven regions around the U.S., including New Jersey, Colorado, Arkansas and Oregon as well as parts of New York, Oklahoma and Ohio. The 2,188 participating providers in 2015 served almost 2.7 million patients, of which 410,177 were Medicare or Medicaid beneficiaries. In 2014, 492 practices, serving 345,000 Medicare and Medicaid beneficiaries among 2.5 million patients, participated in the CPC initiative. The CPC initiative incorporated a dual payment model that included a monthly care management fee (non-visit based), as well as shares in any achieved cost savings.  The new initiative practice model included components like 24/7 access to care, risk-stratified care management, chronic condition and preventive care, and coordinated care across provider teams. After completing the second year of the project, CMS reports that CPC produced $57.7 million in gross savings, almost twice what the initiative produced in its first year.  However, there was limited savings to CMS, as it paid out almost $58 million in monthly management fees during this second year period. Of the seven regions, Arkansas, Oregon, Colorado and Greater Tulsa, Oklahoma produced net savings. In addition to cost savings, the initiative also produced a significant increase in care quality using a variety of metrics for hospital readmissions, flu immunizations and colorectal cancer screenings. Patients were asked to rate their primary care providers and the poll results indicated high levels of patient satisfaction, particularly in the amount of attention paid to their health issues and support for patient-initiated self-care. In the first year of the CPC initiative, participants saw a 2 percent decline in hospital admissions along with a 3 percent decline in emergency room visits.  Almost 90 percent of practices successfully met first year transformation requirements. In the following year, 95 percent of participating practices had achieved preset care quality goals.  Following the initial success of the CPC initiative, CMS has launched the Comprehensive Primary Care Plus program, also designated as CPC+.  CPC+ is a five year program that will strengthen primary care in Arkansas, Colorado, Michigan, Hawaii, Oklahoma, Montana, New Jersey, Oregon, and Tennessee, as well as regions of Pennsylvania, New York, Ohio, and Kansas/Missouri. CPC+ will use a medical home model that incorporates a monthly fee system and emerging delivery systems like telemedicine to augment care standards in urban and rural communities. Participating practices will receive incentive payments up front, but may need to repay them if certain care metrics are not realized. CMS is also inviting private and state payers to participate in this groundbreaking new initiative.

Article written by: Robert Moghim, M.D. – CEO, Moghim Medical Consulting, Inc.

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