In collaboration with CMS, state Medicaid agencies, commercial health plans, self-insured businesses, and independent primary care practitioners, the multi-year Comprehensive Primary Care (CPC) initiative aims to improve the quality and cost of healthcare by expanding access to high-quality primary care to individuals.

 

As a multi-payer initiative, Medicare will work with commercial and state health insurance plans and offer bonus payments to primary care doctors that provide more coordinated care for their patients. Participating primary care practices will be given resources to provide additional medical services and better manage care for their Medicare patients.

 

The Affordable Care Act created the CMS Innovation Center in order to test innovative payment and service delivery models, with the goal of reducing healthcare costs while at the same time preserving or enhancing the quality of care.

 

Under the Comprehensive Primary Care Initiative, CMS estimates that about 313,000 Medicare beneficiaries will be served by 2,144 providers.

 

Private payers such as Humana, Aetna, UnitedHealthcare and Amerigroup have signed on to participate in certain geographic areas.

 

“We believe this program will provide extensive testing and growth of technologies used to manage healthcare and track clinical results. This collaboration is a natural progression of our efforts to better align payments to improved population health,” said Elizabeth Curran, head of Aetna’s National Network Strategy and Program Development, in a statement.

Humana said that the initiative will help primary care practices leverage a framework that can drive more coordinated care.

“By collecting data that pertains to cost, quality and member satisfaction, the Comprehensive Primary Care initiative enables Humana to identify and drive greater efficiencies while delivering quality, affordable healthcare to our members in their quest to achieve well-being,” said Renee Buckingham, vice president of provider engagement for Humana, in a statement.

 

For patients, this means participating physicians will provide a variety of extra or enhanced healthcare services, which may include:

Eligible primary care practices will start delivering these new healthcare services as part of the national medical home initiative this fall. 

 

“Primary care practices play a vital role in our healthcare system and we are looking at ways to better support them in their efforts to coordinate care for their patients” said Acting CMS Administrator Marilyn Tavenner in a statement.

 

Participating practices were selected by CMS based on their use of health information technology, ability to demonstrate recognition of advanced primary care delivery by leading clinical societies, service to patients covered by participating payers, participation in practice transformation and improvement activities, and diversity of geography, practice size, and ownership structure.

 

The Comprehensive Primary Care Initiative began in fall 2011 when CMS started soliciting a diverse pool of commercial health plans, state Medicaid agencies, and self-insured businesses to work alongside Medicare to support comprehensive primary care. Public and private health plans in Arkansas, Colorado, Oregon, and New Jersey have signed letters of intent with CMS to participate in the initiative. In addition, the Capital District-Hudson Valley region of New York, Ohio and Kentucky’s Cincinnati-Dayton region, and Greater Tulsa Oklahoma are participating.

 

Under the Comprehensive Primary Care Initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. At the same time, participating commercial, state, and other federal insurance plans will also offer enhanced payment to primary care practices that are designed to support them in providing high-quality primary care on behalf of their members. The commercial payers are in the process of determining participation and payment arrangements. Both Medicare and commercial membership will be eligible.

 

More information about the CPC initiative, including participating markets and details of the medical home criteria, can be found here.