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 October 2015, there are 442 CPC practice sites, distributed across seven CPC regions, based on data from the 16th quarter of CPC. To view an interactive map of this Model, visit the Where Innovation is Happening page.
In total, 2,188 participating providers are serving approximately 2,700,000 patients, of which approximately 410,177 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 three 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: Brunswick Family Practice | Troy, NY
From the CPC archive: Analysis of the top diagnosis codes in his practice helped James Aram, MD, select radiological screening options for patients with low back pain as a focus for shared decision making in February 2013. This issue was clinically relevant to his patient population, and research clearly showed opportunities to lower costs and reduce unnecessary radiation exposure.
After consulting with their EHR vendor to develop the appropriate data collection and reporting functions, Dr. Aram’s team developed a video decision aid patients could view before the appointment. Patients can view the video through the patient portal, so that they can share information at home with caregivers or family and offers greater opportunity for the patient’s involvement in shared decision making with the practitioner.
As of May 2014, practice data show 79 percent of eligible patients had viewed the decision aid, and radiology studies among eligible patients had dropped more than 4 percentage points. In addition to reduced costs associated with fewer radiological studies, no patient adverse events have occurred since implementing this strategy into the practice.
- Comprehensive Primary Care Initiative: First Evaluation Report (PDF)
- Comprehensive Primary Care Initiative: First Year Evaluation Results Blog Post
- Comprehensive Primary Care Initiative: Second Year Evaluation Report (PDF)
- Comprehensive Primary Care Initiative: Shared Savings Methodology (PDF)
- Comprehensive Primary Care Initiative: 2015 Shared Savings & Quality Data Summary (PDF)
- Comprehensive Primary Care Initiative: 2015 Shared Savings & Quality Results Blog Post
- Comprehensive Primary Care Initiative: eCQM benchmarking Report (PDF)
- Comprehensive Primary Care Initiative 2015 Mid-Year Fast Facts (PDF)
- Comprehensive Primary Care Initiative: Practice Spotlights (PDF)
- Comprehensive Primary Care Initiative Pathways Program Year 2015 (PDF - 64 MB)
- Comprehensive Primary Care Initiative: Resources