CMS Announces New Comprehensive Primary Care Initiative

October 3, 2011 | Health Services

The U.S. Department of Health and Human Services (HHS) announced on September 28, 2011, the launching of the Comprehensive Primary Care (CPC) initiative. This is another initiative made possible by the Affordable Care Act to promote greater integration, collaboration, and coordination among providers in the delivery of efficient and quality of care.

Led by the Center for Medicare and Medicaid Services (CMS), the CPC initiative is aimed at strengthening the provision of patient-centered care. CMS will work with commercial and state health insurance plans to offer support to primary care physicians, and will offer incentive bonuses to providers for better coordination and delivery of quality care in a cost-effective manner. The initiative will test two models simultaneously: (i) a service delivery model and (ii) a payment model.

The service delivery model will test the delivery of the following comprehensive primary care functions:

  • Risk-stratified care management: Primary care practices will be able to proactively assess their patients to determine their needs and provide appropriate and timely preventive care.
  • Access and continuity: Primary care practices must be accessible to patients on a 24/7 basis and be able to utilize patient data tools to give real-time healthcare information to patients in need.
  • Planned care for chronic conditions and preventive care: Participating primary care practices will deliver intensive care management for the patients with high needs and create a plan of care that fits a patient’s individual circumstances and values.
  • Patient and caregiver engagement: Primary care practices will have the ability to actively engage patients and their families to participate in their care.
  • Coordination of care across the medical neighborhood: Primary care doctors will work together with other healthcare providers and the patient to make decisions as a team. Access to and meaningful use of electronic health records should be used to support these efforts.

In the payment model, CMS will pay primary care practices a monthly care management fee, in addition to the usual Medicare fees for covered services, for implementing the outlined comprehensive primary care functions. For the first two years of the initiative, the per-beneficiary, per-month (PBPM) amount will average to $20; and for years three and four, the PBPM will be reduced to an average of $15. Additionally, for years three and four, providers will have the potential to share in any savings to the Medicare program.

The CPC initiative will begin as a demonstration project in five to seven healthcare markets across the country, and will be selected based on the prevalence of payers participation. Preference will be given to markets where the payers are interested in including rural counties in their boundary of a market. The initiative contemplates the enrollment of approximately 75 primary care practices per market.

Participating payers may be commercial insurers, Medicare Advantage plans, states (through the Medicaid program, state employees program, or other insurance purchasing), Medicaid/CHIP managed care plans, high risk pools, self-insured businesses, and administrators of a self-insured group. To be eligible, payers must meet the following requirements:

  • Payers must commit to enter into compensation contracts with primary care practices selected for the initiative. All practices selected must support the comprehensive primary care functions.
  • Payers must commit to enter into compensation contracts with primary care practices selected for this initiative that includes the opportunity for practices to qualify for shared savings.
  • Payers must share with CMS their attribution methodologies.
  • Payers must be willing to provide participating practices with aggregate and member-level data about cost and utilization for members receiving care from practices participating in the initiative.
  • Payers must be willing to align quality, practice improvement, and patient experience measures with CMS Innovation Center and other payers in their market for purposes of monitoring implementation milestones, quality improvement, and patient experience.
  • Payers must provide information on the markets in which they are interested in participating.

Letters of Intent for participation in the CPC initiative, along with a description of the geographic service area, must be submitted to CMS by November 15, 2011. Final applications must be received on or before January 17, 2012. More information about the CPC initiative and details about participation can be found at http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/cpci/.

 All rights reserved.  Reprinted with persmission.

 






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