It is called the CPC (Comprehensive Primary Care) initiative, and aims to strengthen coordination and collaboration between private and public health care payers in order to improve primary care. According to Medicare, it will liaise with both commercial and State health insurance plans and offer financial incentives to primary care physicians who effectively coordinate care for patients in their care.

CMS (Center for Medicare and Medicaid Services) says that primary care practices that opt to take part in this initiative will receive money to help them better coordinate primary care for their patients on Medicare.

Primary care is not only vital for the promotion of health and better care, it can bring down overall system costs when integrated properly. However, in the USA, this part of health care provision has been under-valued and under-funded.

The CPC Initiative wrote online:

“Without a significant enough investment across multiple payers, independent health plans– covering only their own members and offering support only for their segment of the total practice population– cannot provide enough resources to transform entire primary care practices and make expanded services available to all patients served by those practices.”

Patients tend to go to primary care practices as their first point of call for their health care needs – they are key points of contact. If primary care is strengthened and coordination improved, clinicians can more easily work together, and are able to spend more time with each patient. Over the last few years, new ways have emerged to put these improvements into practice.

CMS says that all over the USA, health plans and health providers have been investing more in primary care. Employers report that health plans that focus on well coordinated primary care help create a healthier workforce.

The Initiative will start in 5-7 selected sites across the USA. CMS claims it offers a “break through in this historical impasse by inviting payers to join with Medicare”.

The resources doctors receive are aimed to help them:

  • Manage high health care need patients – individuals with serious conditions and illnesses, or multiple medical conditions require more support to make sure they are receiving necessary medical care and/or drugs. Primary care practices participating in this initiative will be able to provide intensive care management for high-need patients. Care can be tailored to each patient’s unique circumstances and values.
  • Making sure there is access to care – it is important that access to primary care services are accessible to patients round-the-clock.
  • Delivering preventive care – primary care physicians and practices in general that participate in this initiative will find it easier to proactively assess patients, determine their requirements, as well as providing timely and suitable preventive care.
  • Patients and their caregivers – practices will be able to engage patients and household members so that they all may participate actively in their care.
  • Coordinate care across multiple providers in the community – as primary care is usually the first point of contact for most patients, it should take the lead in coordinating patient care. Participating primary care practices will liaise closely with patients’ other health care providers, as well as the patient, deciding on treatment options as a team. Effective use of electronic health records is vital.

Two models will be tested by the CDC – a payment model and a service delivery model:

Service Delivery Model – comprehensive primary care will be tested. The following five functions should be present:

  • Continuity and access
  • Engaging patients and their caregivers
  • Risk-stratified Care Management
  • Planning for chronic conditions, as well as preventative care
  • Coordination of care across the medical community

Payment Model – a management fee is pain every month to some primary care practices on behalf of their fee-for-service Medicare patients. When the initiative is in its second to fourth year, they will have to potential to share in any savings to the Medicare program.

Other payers who are taking part in the initiative will also compensate primary care practices – these include insurance companies and other health plans. The aim is “to integrate multi-payer funding streams to strengthen their capacity to implement practice-wide quality improvement.”

The following were selected from a pool of applicants – the CMS Innovation Center announced the following selected areas to represent selected markets:

  • Arkansas: Statewide
  • Colorado: Statewide
  • New Jersey: Statewide
  • New York: Capital District-Hudson Valley Region
  • Ohio: Cincinnati-Dayton Region
  • Oklahoma: Greater Tulsa Region
  • Oregon: Statewide

All the above-mentioned markets are multi-payers and could include employers, state Medicaid agencies, and private health plans.

CMS wrote:

“The participating payers in each market will be entering into a Memorandum of Understanding with CMS.

Once the participating payers in each market have agreed to the terms and conditions of this MOU, the Innovation Center will then release a solicitation to primary care practices in these geographic areas wishing to participate in providing comprehensive primary care as part of this initiative.

Approximately 75 primary care practices in each designated market will be selected to participate.”

Written by Christian Nordqvist