Primary Care Initiative Minimizes Physician Shortage Worries

One of many ways the Obama Administration is working with CMS to deliver better, more affordable health care to more people, is through the development of the CMS Innovation Center, which is tasked with finding more effective, more affordable, higher quality health care, for more people.  With a potential physician shortage, finding ways to eliminate that threat are comforting.  And so is finding a way, at the same time, to accomplish the Innovation Center’s goals. CMS has taken another stride toward accomplishing this work-in-progress, as it has just announced that 500 primary care practices in seven regions have been selected to participate in a new partnership between payers from the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, commercial health plans, self-insured businesses, and primary care providers. This partnership is designed to provide improved access to quality health care at lower costs.

Under this Comprehensive Primary Care Initiative, CMS will pay selected 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. State, federal, and commercial insurance plans are also offering this type of enhanced payment to primary care practices that is designed to support the practices, as they provide high-quality primary care on behalf of their members.

The hope for this initiative is that beneficiaries will have access to physicians for longer and more flexible hours, that physicians will use electronic health records and 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 higher needs.

Earlier this year in April, we covered CMS choosing the geographic markets to participate in the initiative. 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. 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.

CMS used a competitive application process to choose primary care practices within the selected markets to participate in the Comprehensive Primary Care initiative. Practices were chosen based on their: (1) use of health information technology; (2) ability to demonstrate recognition of advanced primary care delivery by leading clinical societies; (3) service to patients covered by participating payers; (4) participation in practice transformation and improvement activities, and (5) diversity of geography, practice size, and ownership structure.

And perhaps most important, CMS estimates that over 300,000 Medicare beneficiaries will be served by over 2,000 providers through this initiative, making it possible to do more with less while still improving care. “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.

Even the Institute of Medicine has a brand new report which identifies three major areas for change in our nation’s approach to health care, which are: “the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential.”  The report also points out that emerging tools like “computing power, connectivity, team-based care, and systems engineering techniques,” things like what the CMS Innovation Center is using, which “make the envisioned transition possible, and are already being put to successful use in pioneering health care organizations… can support the transition to a continuously learning health system, one that aligns science and informatics, patient-clinician partnerships, incentives, and a culture of continuous improvement to produce the best care at lower cost.”

The Comprehensive Primary Care initiative is a four-year initiative administered by the Center for Medicare and Medicaid Innovation (CMSInnovationCenter).  TheCMSInnovationCenterwas created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care.