The Comprehensive Primary Care (CPC) initiative is a four-year multi-payer initiative designed to strengthen primary care. Since CPC’s launch in October 2012, CMS has collaborated with commercial and State health insurance plans in seven U.S. regions to offer population-based care management fees and shared savings opportunities to participating primary care practices to support the provision of a core set of five “Comprehensive” primary care functions. These five functions are: (1) Risk-stratified Care Management; (2) Access and Continuity; (3) Planned Care for Chronic Conditions and Preventive Care; (4) Patient and Caregiver Engagement; (5) Coordination of Care across the Medical Neighborhood. The initiative is testing whether provision of these functions at each practice site — supported by multi-payer payment reform, the continuous use of data to guide improvement, and meaningful use of health information technology — can achieve improved care, better health for populations, and lower costs, and can inform future Medicare and Medicaid policy.
The Participating Practices
As of May 26, 2015 there are 470 CPC practice sites, distributed across seven CPC regions, based on data from the 11th quarter of CPC. To view an interactive map of this Model, visit the Where Innovation is Happening page.
In total, 2,805 participating providers are serving approximately 2,668,272 patients, of which approximately 404,150 are Medicare & Medicaid beneficiaries. There are 38 public and private payers participating in the Comprehensive Primary Care initiative (List).
Historically, primary care has been underfunded in the United States. Without a critical mass of payers, investments in primary care made by individual payers—addressing only their respective portion of a practice’s patient population—cannot provide sufficient funding for the practice-wide changes needed to transform primary care. CPC is designed to address this impasse through multi-payer collaboration.
The seven CPC regions were chosen after soliciting interest from payers nationally. Regions with the highest collective market penetration of payers willing to align their payment models to support the five CPC functions were selected. Eligible practices in each market were invited to apply to participate and start delivering enhanced health care services in the fhall of 2012. Practices were selected in mid-2012 through a competitive application process in each selected region based on their use of health information technology, ability to demonstrate recognition of advanced primary care delivery by accreditation bodies, service to patients covered by participating payers, participation in practice transformation and improvement activities, and diversity of geography, practice size and ownership structure. The CPC initiative is currently in program year two of four and scheduled to end in December 2016.
The CPC initiative integrates a defined payment model with a specific practice redesign model to support improved care, better health for populations, and lower health costs through improvement:
Participating primary care practices receive two forms of financial support on behalf of their fee-for-service (FFS) Medicare beneficiaries:
- A monthly non-visit based care management fee.
- The opportunity to share in any net savings to the Medicare program.
Read more about Medicare Program
Practice Redesign Model
CPC provides resources to help practices work with patients to provide the following five comprehensive primary care functions:
- Access and Continuity: Because health care needs and emergencies are not restricted to office operating hours, primary care practices optimize continuity and timely, 24/7 access to care guided by the medical record. Practices track continuity of care by provider or panel.
- Planned Care for Chronic Conditions and Preventive Care: Participating primary care practices proactively assess their patients to determine their needs and provide appropriate and timely chronic and preventive care, including medication management and review. Providers develop a personalized plan of care for high-risk patients and use team-based approaches like the integration of behavioral health services into practices to meet patient needs efficiently.
- Risk-Stratified Care Management: Patients with serious or multiple medical conditions need extra support to ensure they are getting the medical care and/or medications they need. Participating primary care practices empanel and risk stratify their whole practice population, and implement care management for these patients with high needs.
- Patients and Caregiver Engagement: Primary care practices engage patients and their families in decision-making in all aspects of care, including improvements in the system of care. Practices integrate culturally competent self-management support and the use of decision aids for preference sensitive conditions into usual care.
- Coordination of Care Across the Medical Neighborhood: Primary care is the first point of contact for many patients, and takes the lead in coordinating care as the center of patients’ experiences with medical care. Practices work closely with patients’ other health care providers, coordinating and managing care transitions, referrals, and information exchange.
Read more about Medical Neighborhood Coordination
For more information, please send your questions to CPCi@cms.hhs.gov.
Practice Spotlight: Grants Pass Clinic, Grants Pass, OR
From the CPC archive: “When we saw the CPC utilization baseline data for the first time, that was terrific,” Bruce Stowell, MD, Chairman of the Partnership for Grants Pass Clinic in Oregon, said. That validation through data is an aspect of CPC that Grants Pass Clinic has found rewarding. “We always thought we were doing a good job from a cost-effective standpoint, but to see it in the data, that was the first time we actually knew how well we were doing.”
Grants Pass Clinic is a provider-owned multispecialty group serving the Josephine County community in rural southwestern Oregon. While the clinic has long operated a team-based care approach, other aspects of CPC have allowed the clinic to grow into a high-functioning medical home by adding staff and deepening its care management work.
As we worked on PCMH and other initiatives, everyone brought more to the table, and all of that collegiate group activity was exciting,” Dr. Stowell noted. “We like working in a group, and we’re here to make things better for our patients. Over the course of these initiatives, we’ve gone from 20 siloed individual practices to 120 people all trying to go in the same direction, which is very exciting.”
- Comprehensive Primary Care Initiative: First Evaluation Report (PDF)
- Comprehensive Primary Care Initiative: First Year Evaluation Results Blog Post
- Comprehensive Primary Care Initiative: Shared Savings Methodology (PDF)
- Comprehensive Primary Care Initiative: 2014 Shared Savings & Quality Results Blog Post
- Comprehensive Primary Care Initiative: Memorandum of Understanding (MOU) (PDF)
- Comprehensive Primary Care Initiative: Practice Spotlights (PDF)
- Comprehensive Primary Care Initiative Pathways Program Year 2014 (PDF - 32 MB)
- Comprehensive Primary Care Initiative: By the Numbers (PDF)
- Comprehensive Primary Care Initiative: 2013 Revenue and Expenses Fast Facts (PDF)
- Comprehensive Primary Care Initiative: Resources