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
In total, 2,725 participating providers are serving approximately 2,732,278 patients, of which approximately 408,599 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 fall 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 expand icon Read More
Participating practices receive a monthly care management fee for each Medicare fee for service (FFS) beneficiary and, in cases where the state Medicaid agency is participating, for each Medicaid FFS beneficiary. The monthly payment from Medicare averages $20 per beneficiary per month during years 1-2 of the initiative (2013-14), and decreases to an average of $15 per beneficiary per month during years 3-4 (2015-16). Practices also receive monthly fees from other participating CPC payers and are expected to combine CPC revenues across payers to develop a whole-practice transformation strategy.
Additionally, CMS is offering each CPC practice the opportunity to share net savings generated from improved care to Medicare beneficiaries attributable to the practice. Annually in 2014-16, savings to the Medicare program will be calculated at a regional level and distributed to practices according to their performance on quality metrics. Practices have similar shared savings opportunities with other CPC payers in their region.
The other payers in the seven regions encompass public and private payers spanning commercial, Medicare Advantage, Medicaid managed care, and Third Party Administrator/Administrator Services Only lines of business, as well as four state fee-for-service (FFS) Medicaid agencies (Arkansas, Colorado, Ohio, and Oregon). CMS is funding the enhanced payment models offered by state FFS Medicaid agencies. Other CPC payers receive no payment from CMS.
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. expand icon Read More
For more information, please send your questions to CPCi@cms.hhs.gov.
Practice Spotlight: Oregon Medical Group Eugene, OR
From the CPC archive: At first, integrating behavioral health was an intimidating task for Kathleen. “It’s big and it can be hard to do,” she said. “Our physicians knew they needed this in our practice, but it takes time to make it work.”
However, when it works, it immediately makes a difference for patients who need the services.
“One Friday afternoon at the end of the patient visit, we identified a patient who was clearly in crisis with suicidal ideation,” Terry recounted. “The physician connected the patient to our behavioral health specialist with a warm handoff through a phone call. The specialist evaluated the patient over the phone and set up an appointment for him on Saturday morning.”
Terry continued, “She also set up a crisis plan if he worsened overnight. They talked about who he should call and where he should go if he felt he needed help. He understood that help was waiting for him the next day, but just in case, he had a plan.”
The patient was seen the following day and started treatment.
“Our physicians are thrilled,” Kathleen said. “They are relieved that we can help people like this and it’s amazing to get the right services at the right time. That’s what it means to be a patient’s medical home.”
- Comprehensive Primary Care Initiative: First Evaluation Report (PDF)
- Comprehensive Primary Care Initiative: Memorandum of Understanding (MOU) (PDF)
- Comprehensive Primary Care Initiative: Practice Spotlights - June 2014–December 2014 (PDF)
- Comprehensive Primary Care Initiative: Practice Spotlights - November 2013–June 2014 (PDF)
- Comprehensive Primary Care Initiative: By the Numbers (PDF)
- Comprehensive Primary Care Initiative: 2013 Revenue and Expenses Fast Facts (PDF)
- Comprehensive Primary Care Initiative: Resources