Can Investment in Primary Care Save Money for Medicare?

 CMS announced that a number of insurers (commercial, federal, and state) have agreed to partake in the Comprehensive Primary Care (CPC) initiative to strengthen primary care in selected markets.  So far, 45 insurers have agreed to participate in the initiative, in the seven selected markets: the States of Arkansas, Colorado, New Jersey, Oregon; the Capital District-Hudson Valley Region of New York; Cincinnati-Dayton Region of Ohio and Kentucky; and the Greater Tulsa Region of Oklahoma.  The thought is that, although historically primary care has not been given much value or funding in this country, by focusing on improving and better coordinating primary care, beneficiaries will receive better quality care while reducing costs. 

The CPC initiative is a collaboration between public and private health care payers, including private health plans, state Medicaid agencies, and employers, where payers will provide bonus payments and resources to primary care doctors at participating practices to provide more coordinated care to their Medicare patients. Ultimately, around 75 primary care practices will be chosen to participate in the initiative in each market.  CMS will then pay a $20 care management fee, per beneficiary per month, to participating primary care practices.  To receive the fee, the practices must agree to provide enhanced services to patients: (1) ensure access to care at all times of the day or night; (2) utilize electronic health records; (3) deliver preventive care; (4) coordinate care for patients among all of the patient’s health care providers to make decisions as a team; (5) engage patients and caregivers to actively participate in the patient’s care; and (6) manage care for patients with serious or multiple medical conditions or higher needs.

According to the Center for Medicare & Medicaid Innovation, without coordination between payers, individual health plans overseeing only its members have no hope to transform primary care practices alone.  Primary care is seen as “critical to promoting health, improving care, and reducing overall system costs…” and is the “key point of contact for patients’ health care needs.”  While other initiatives have been created in the last few years to improve primary care– better coordination, allowing providers to work together, and spending more time with patients– the CPC Initiative seeks to further build upon those efforts.

Acting CMS Administrator Marilyn Tavenner stated that, “[w]e know that when we support primary care, we get healthier patients and lower costs.”  Just how much of an improvement will result will be better seen at the end of this initiative. 

Practices interested in participating in the four-year CPC initiative are encouraged to apply online at the Innovation Center’s website before July 20.