CMS announces participation of PCPs in Comprehensive Primary Care Initiative

The American College of Physicians (ACP) today praised the Centers for Medicare and Medicaid Services (CMS) for its announcement of primary care practices to participate in a historic public-private partnership to strengthen primary care, the Comprehensive Primary Care Initiative (CPCI).

In support of more effective, affordable, and higher quality health care, 500 primary care practices in seven regions have been selected to participate in a new partnership among payers from CMS, state Medicaid agencies, commercial health plans, self-insured businesses, and primary care providers. The partnership is designed to provide improved access to quality health care at lower costs.

"The Administration and the CMS deserve tremendous credit for advancing this vital initiative, which moves to another critical stage with today's announcement," said ACP president David L. Bronson, MD, FACP. "We are extraordinarily pleased with the CPCI's focus on patient-centered care and practice redesign."

Under the CPCI, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state, and other federal insurance plans are also offering enhanced payment to primary care practices that are designed to support them in providing high-quality primary care on behalf of their members.

"The CPCI is an important step in supporting patient-centered medical homes," said Robert A. Gluckman, MD, FACP, chairman of ACP's Medical Practice and Quality Committee and chief medical officer for a participating payer in Oregon. "This program allows Medicare and private insurers to provide the needed resources so practices can improve care for all their patients."

For patients, this means these physicians may offer longer and more flexible hours, use electronic health records; coordinate care with patients' other health care providers; better engage patients and caregivers in managing their own care, and provide individualized, enhanced care for patients living with multiple chronic diseases and greater needs.

"The CPCI is the kind of common sense investment in health care we need," said Health and Human Services Secretary Kathleen Sebelius. "Businesses, families, and taxpayers all benefit from a stronger primary care system that helps to improve our health and lower costs."

The initiative started in the fall of 2011 with CMS soliciting a diverse pool of commercial health plans, state Medicaid agencies, and self-insured businesses to work alongside Medicare to support comprehensive primary care. Public and private health plans in Arkansas, Colorado, New Jersey, Oregon, New York's Capital District-Hudson Valley region, Ohio and Kentucky's Cincinnati-Dayton region, and the Greater Tulsa region of Oklahoma signed letters of intent with CMS to participate in this initiative. The markets were selected in April 2012 based on the percentage of the total population covered by payers who expressed interest in joining the partnership.

Eligible primary care practices in each market were invited to apply to participate and start delivering enhanced health care services in the fall of 2012. Through a competitive application process, primary care practices within the selected markets were chosen to participate in the CPCI. Practices were chosen based on their use of health information technology, ability to demonstrate advanced primary care delivery, service to patients covered by participating payers, participation in practice transformation and improvement activities, and diversity of geography, practice size, and ownership structure. CMS estimates that more than 300,000 Medicare beneficiaries will be served by more than 2,000 providers through this initiative.

"Primary care practices play a vital role in our health care system and we are looking at ways to better support them in their efforts to coordinate care for their patients" said Acting CMS Administrator Marilyn Tavenner. "By engaging in this unprecedented and innovative public-private partnership we aim to create a payment model that allows our primary care practices to take a lead role in delivering improved overall coordinated care for their patients. Our goal is to see healthier families across our nation and to generate savings for providers, insurers and taxpayers."