Multi-Payer Advanced Primary Care Practice

Under this demonstration, CMS participated in multi-payer reform initiatives that were conducted by states to make advanced primary care practices more broadly available. The demonstration evaluated whether advanced primary care practice reduced unjustified utilization and expenditures, improved the safety, effectiveness, timeliness, and efficiency of health care.

The Participating MAPCP

Select anywhere on the map below to view the interactive version Multi-Payer Advanced Primary Care Practice Mapped

 

There were 5 states participating in the Multi-Payer Advanced Primary Care Practice Demonstration. (List)

Background

This demonstration began in 2011 with eight states participating: Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont. Each project was conducted and coordinated by the participating state and included Medicaid and substantial participation by private health insurers. The demonstration was initially planned to last for three years in each state.

Initiative Details

The demonstration program paid a monthly care management fee for beneficiaries receiving primary care from advanced primary care (APC) practices. The care management fee was intended to cover care coordination, improved access, patient education and other services to support chronically ill patients. Additionally, each participating state had mechanisms to offer APC practices community support and linkages to state health promotion and disease prevention initiatives.

Medicare participation in three of the state’s programs (Vermont, New York, and Rhode Island) started July 1, 2011. Two additional states (North Carolina and Michigan) were effective October 1, 2011 and the three remaining states became operational January 1, 2012. Each state’s program was planned to be operational for 3 years. By the end of the three year demonstration approximately 1200 medical homes serving over 900,000 Medicare beneficiaries were expected to be participating.

In early 2014 a decision was made to extend the demonstration in all states through the end of 2014, and in September 2014 CMS announced that it would offer six of the eight states participating in the MAPCP demonstration the opportunity to extend the demonstration through 2016. The offer to extend the demonstration was made to those states for which some of the MAPCP Demonstration payment goes to community based organizations that could not bill independently under the Chronic Care Management (CCM) codes that took effect in January, 2015. Five states (Maine, Michigan, New York, Rhode Island, Vermont) accepted the offer and continued participation in this demonstration through 2016.

Additional Information