CMS Taking Applications for Comprehensive Primary Care Initiative

CMS is taking applications for participation in the Comprehensive Primary Care (CPC) Initiative demonstration project. This demonstration project, authorized under § 3021 of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), will pay providers $20 a month  per beneficiary who coordinate care for these Medicare beneficiaries. After two years they will be able to obtain a share the savings that resulted from the coordination of care. The CPC initiative is a new CMS-led, multi-payer initiative fostering collaboration between public and private health care payers.

The demonstration project will be available in only five to seven markets across the country. Markets will be chosen based on where a preponderance of health care payers apply, are selected, and agree to participate. The goal is to enroll approximately 75 practices per market and to have diverse geographic representation.

 Services

 Care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients. The resources will help doctors work with patients to ensure they:

  • (1) Manage care for patients with high health care needs. Participating primary care practices will deliver intensive care management for patients with high needs. By engaging patients, primary care providers can create a plan of care that uniquely fits each patient’s individual circumstances and values.
  • (2) Ensure access to care. Because health care needs and emergencies are not restricted to office operating hours, primary care practices must be (i) accessible to patients 24 hours a day 7 days a week, and (ii) be able to utilize patient data tools to give real-time, personal health care information to patients in need.
  • (3) Deliver preventive care. Primary care practices in the demonstration will be able to proactively assess their patients to determine their needs and provide appropriate and timely preventive care.
  • (4) Coordinate care across the medical neighborhood. Under this initiative, primary care doctors and nurses will work together and with a patient’s other health care providers and the patient to make decisions as a team. Access to and meaningful use of electronic health records should be used to support these efforts.

 Payment and Participants

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. 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.

The CPC initiative will invite other  payers to join with Medicare in investing in primary care. 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. After the markets are selected based on payer participation, CMS and all participating payers will enroll primary care practices in those selected markets who agree to offer the expanded package of services called for in the initiative.

The American Medical Association applauded the launch of the CPC initiative.  “This new initiative is an exciting opportunity that will provide physicians with the resources and data they need to work with the Centers for Medicare and Medicaid Services (CMS), private health insurers, employers and patients to transform care at the local level,” said Peter W Carmel, MD, President of the American Medical Association.

Final applications, to be completed only after the letter of intent has been submitted, must be received on or before January 17, 2012.

 

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