Comprehensive Primary Care Initiative (CPC)

November 3, 2011 – The CPC is a new CMS-led, (through their Innovation Center), multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care services, which CMS states has been historically under-funded and under-valued in the US.  CMS will be soliciting other payers, including Medicaid, that are currently providing or willing to provide, enhanced support above and beyond visit based fee-for-service payments for primary care practices in their networks. 
 
Each payer will propose a strategy that is aligned with the Innovation Center’s to support the fundamental elements of comprehensive primary care aimed at reducing total health system costs while achieving better health and improved experience of care.  Selected markets will be comprised of areas in which a dominance of payers has offered aligned strategies.
 
The program will start as a four-year demonstration program in five to seven markets across the country and will include approximately 75 practices in each market.
 
CMS has asked public and private payers to indicate their interest to CMS, including the level and type of support for primary care practices being offered by submitting a nonbinding letter of intent and a completed Geographic Service Area Worksheet by November 15, 2011.  Final applications by the carriers must be received on or before January 17, 2012. 
 
Once CMS evaluates the proposals and selects the markets, a second solicitation will be issued for primary care physicians in those markets.  In order for a primary care practice to qualify for the project, four fundamental elements must be in place: 

• Enhanced, accountable payment
• Continuous improvement driven by data
• Optimal use of health IT; and
• A set of the following 5 comprehensive primary care functions:
  1. Be available 24 hours a day to provide medical care and health information
  2. Deliver preventive care
  3. Develop a personalized care plan for patients with serious or chronic diseases
  4. Engage patients and families in their own care
  5. Work together with other physicians, including specialists, to provide coordinated care

The payment model includes a monthly care management fee, an average of $20 per month, paid to the selected primary care practices for each of their Medicare fee-for-service Medicare beneficiaries. In years 2-4 of the initiative, there will be potential to share in any savings to the Medicare program.
 
For more information on this program, please click below.
 
Comprehensive Primary Care Initiative

Tags: Healthcare Reform