The U.S. Department of Health and Human Services (HHS) announced on September 28, 2011 the launch of a new, voluntary Comprehensive Primary Care Initiative (the “Initiative”) funded under the Affordable Care Act. The Initiative, HHS says, will incentivize primary care practices “to deliver higher quality, more coordinated and patient-centered care,” which can lower health care costs.
Under the new Initiative, Medicare will partner with other health care payers including commercial health insurers and state health insurance plans, to offer financial support to participating primary care doctors to help them better coordinate care for their patients, and also give them the chance to participate in any future health care cost savings that result for the payers. Participation in the Initiative by commercial and state payers and primary care doctors will be voluntary, not required.
“Thanks to the Affordable Care Act, we are helping primary care doctors better coordinate care with patients so they get better care and we use our health care dollars more wisely,” HHS Secretary Kathleen Sebelius said in a release issued by HHS on September 28.
“This collaboration, known as the Comprehensive Primary Care Initiative, is modeled after innovative practices developed by large employers and leading private health insurers in the private sector,” HHS said.
On a page of HealthCare.gov relating to the Comprehensive Primary Care Initiative, HHS cites examples of successes achieved by the private sector in lowering health care costs and improving care through better coordination of care, focusing on use of primary care practices as patients’ primary point of contact with the health care system. These and other private sector examples, HHS says, have inspired the new Comprehensive Primary Care Initiative.
Following are some of the private sector examples cited, in which investing in primary care has improved outcomes and lowered costs of care, according to HHS:
* Group Health Cooperative of Puget Sound reduced emergent and urgent care visits by 29% and hospital admissions by 6%.
* Geisinger Health Plan’s program reduced admission rates by 18% and hospital readmissions by 36% per year.
* Employers across the country have found that with health coverage policies that emphasize primary care, coordinated care, and other strategies that keep their employees healthy, they not only support a healthier workforce, they create a healthier bottom line.
Initial Demonstration Project for the Comprehensive Primary Care Initiative
The voluntary Comprehensive Primary Care Initiative will begin as a demonstration project available in five to seven health care markets across the country. Public and private health care payers interested in applying to participate in the demonstration project must submit a Letter of Intent by November 15, 2011.
“Markets will be chosen based on where a preponderance of health care payers apply, are selected, and agree to participate, and the goal is to have diverse geographic representation,” HHS announced. “Payers may be commercial insurers, Medicare Advantage plans, states (through the Medicaid program, state employees program, or other insurance purchasing), Medicaid/CHIP managed care plans, high risk pools, self-insured businesses or administrators of a self-insured group (TPA/ASO),” HHS said.
In the markets selected, Medicare and its partners will then enroll interested primary care providers into the Initiative.
Primary care practices that choose to participate in this Initiative will be given support to better coordinate primary care for their Medicare patients, and a chance to receive a bonus in the form of participation in any future health care cost savings generated for the participating payers (Medicare, as well as participating private insurers, and state health plans) through such better coordinated care.
Participating primary care doctors will agree to implement improvements in coordination of care, including the following, according to the HHS release:
* Give patients 24-hour access to care and health information;
* Deliver preventive care;
* Engage patients and their families in their own care;
* Work together with other doctors, including specialists, to provide better coordinated care.
In return, as explained on HealthCare.gov, “Under the Comprehensive Primary Care Initiative, CMS will pay primary care providers for improved and comprehensive care management, and after two years offer them the chance to share in any savings they generate. CMS will look to collaborate with other payers in local markets who will commit to similar changes to how they engage primary care practices.”
The payment model to be implemented is summarized on HealthCare.gov as follows:
- “Monthly Care Management Fees for Medicare Fee-for-Service Beneficiaries: CMS will pay participating practices a risk adjusted, monthly care management fee for their Medicare Fee-for-Service beneficiaries. For the first two years of the initiative, the per-beneficiary, per-month (PBPM) amount will average out to $20; for years 3 and 4, the PBPM will be reduced to an average of $15.
- Shared Savings in Medicare Fee-for-Service: Many studies suggest that it costs less to provide health care to patients who receive care from primary care practices that offer comprehensive services compared to those that don’t provide such services. After two years, all practices participating in this initiative will have the opportunity to share in a portion of the total Medicare savings in their market.”
Inclusion of Medicaid Programs
“This initiative will also provide practices serving people with Medicaid with additional support to allow them to participate,” HHS said. “As part of our solicitation process, state Medicaid programs are invited to apply to participate in the multi-payer approach.”
To the extent that participating primary care practices serve Medicaid beneficiaries on a fee-for-service basis in states that apply to participate in the Initiative, CMS will fund “up to 100% of the additional reimbursement made for newly initiated or newly enhanced primary care services that the state would like to test as part of the Comprehensive Primary Care initiative,” HHS announced. These payments would be made in addition to the regular fee-for-service payments primary care practices receive through the state Medicaid program.
Goals & Implications of the Initiative
“This collaborative approach has the potential to strengthen the primary care system for all Americans and reduce health care costs by using resources more wisely and preventing disease before it happens,” HHS said.
“We know that when doctors have time to spend time with their patients and can better coordinate care with specialists, people are healthier and we have lower costs in the health care system,” said CMS Administrator Donald Berwick, M.D.
The Comprehensive Primary Care Initiative is one of several initiatives being undertaken by the Obama Administration under the Affordable Care Act to promote coordinated care and lower costs for health care for Americans.
Other Initiatives include:
- Accountable Care Organizations (ACOs) — providing another way for doctors, hospitals and other health care providers to work together to better coordinate care for patients, which can help improve health, improve the quality of care, and lower costs.
- The Bundled Payment Initiative — linking together payments for multiple services that patients receive during an episode of care, in order to help improve and coordinate care for patients while they are in the hospital and after they are discharged.
- The Partnership for Patients — bringing together hospitals, doctors, nurses, pharmacists, employers, unions, and state and federal government to keep patients from getting injured or sicker in the health care system and to improve transitions between care settings.
For more information on the Comprehensive Primary Care initiative, see the CMS web site.
For an overview fact sheet about the Comprehensive Primary Care initiative, see HealthCare.gov.
HHS also invites interested parties to obtain answers to specific questions by e-mailing CMS at: CPCi@cms.hhs.gov.
More information about initiatives of the CMS Innovation Center is available in its website.
See related HelpingYouCare™ reports on:
Survey Finds 9 of 10 Health Care Leaders Support Affordable Care Act; 7 of 10 Favor Implementing the Law with Little or No Change (many health care leaders favored provisions involving improved coordination of care);
- News on Health Care Reform
- Editorials: What Needs Improvement, With Your Comments
- Advocacy: Proposals for Reform, With Your Comments
- Legislation: Pending & Recently Adopted
- International Health Care Compare: Information on Health Care & Long-Term Care Solutions in Other Countries
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