500 primary care practices from 7 U.S. regions have been chosen to form a new partnership to offer improved quality health care at affordable costs. The Comprehensive Primary Care Initiative is a 4-year initiative by the Center for Medicare and Medicaid Innovation (CMS Innovation Center) that started in the fall of 2011 and is between care practices and payers from the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, commercial health plans, self-insured businesses, and primary care providers.
The Affordable Care Act created the CMS Innovation Center in order to test innovative payment and service delivery models, which could reduce program expenditures whilst preserving or enhancing the quality of care.
The CMS will pay primary care practices a care management fee under the initiative to support better, coordinated services on behalf of Medicare fee-for-service beneficiaries, which will be initially set at around $20 per beneficiary per month. The same will be done simultaneously by participating state, commercial, and other federal insurance plans on behalf of their members.
This means that patients’ profit from several improvements, such as benefiting from longer and more flexible physician’s hours. Physicians will be able to use electronic health records, coordinate with other health care providers over patients’ health care, enhance patient and caregiver management to manage their own care, and provide individualized, better care for patients with multiple chronic diseases and higher needs.
To support comprehensive primary care working alongside Medicare, the CMS solicited a diverse pool of commercial health plans, state Medicaid agencies, and self-insured businesses. To participate in the initiative, the CMS received signed letters of intent from public and private health plans in states, including New Jersey, New York’s Capital District-Hudson Valley region, Arkansas, Colorado, Ohio and Kentucky’s Cincinnati-Dayton region, Oregon, and the Greater Tulsa region of Oklahoma. In April 2012, the markets were selected by calculating the percentage of the total population covered by payers who wanted to join the initiative.
The CMS invited eligible primary care practices in each market to apply to participate and will start their enhanced health care service initiative in the fall of 2012. The CMS chose primary care practice participants for the Comprehensive Primary Care initiative after evaluating each application in a thorough selection process and made their decisions based on the practice’s 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.
According to the CMS estimations, under the initiative over 2,000 providers will serve more than 300,000 Medicare beneficiaries. Marilyn Tavenner, who is the CMS acting Administrator, said: “Primary care practices play a vital role in our health care system and we are looking at ways to better support them in their efforts to coordinate care for their patients.”
Written by Grace Rattue