CMS announces positive findings of primary care practice initiatives

CMS announced beneficial results for two of its projects, the Comprehensive Primary Care initiative to improve primary care outcomes and reduce costs, and the Multi-payer Advanced Primary Care Practice Demonstration that tested the effectiveness of advanced primary care practices in various states.

“These two programs are part of broader efforts to deliver better care, spend dollars more wisely, and have healthier people and communities,” Patrick Conway, MD, CMS deputy administrator for Innovation and Quality and chief medical officer, wrote on the CMS blog.

Comprehensive Primary Care initiative

The CPC is a multi-payer initiative intended to strengthen primary care, with partnerships between Medicare and Medicaid private health care payers; and primary care practices in four states (Arkansas, Colorado, New Jersey, Oregon) and three regions (New York’s Capital District and Hudson Valley, Ohio; Kentucky’s Cincinnati-Daytona region; and Oklahoma’s Greater Tulsa region.

The initiative’s purpose was to assess whether multi-payer payment reforms, ongoing use of data to guide enhancements and significant use of health information technology can achieve better quality of care and health for populations, lower costs and guide future Medicare and Medicaid policies.

CMS selected 502 practices it considered meaningful users of electronic health records (EHRs), had patient-centered medical home (PCMH) recognition and were experienced in quality improvement initiatives. The initiative’s goals were to provide care management for patients at the most risk, improve health care access, track patient experience, coordinate care with hospitals and specialists and use health information technology to support population health.

“The practices receive non-visit based care management fees from participating payers and the opportunity to share in savings,” Conway said in the CMS blog.

While the expenditure impact varied across all regions, the primary savings findings showed that over 90% of practices met all the first-year milestones, and enough savings were generated in Medicare health expenditures to counterbalance fees paid by CMS. Patients in the highest-risk quartile were typically those that generated savings, and the main cost reductions came from reduced hospital admissions and emergency department visits.

“Results should be interpreted cautiously as effects are emerging earlier than anticipated, and additional research is needed to assess how the initiative affects costs and quality of care, beyond the first year,” Conway said.

Multi-payer Advanced Primary Care Practice Demonstration

The Multi-payer Advanced Primary Care Practice Demonstration (MAPCP) partners Medicare with Medicaid and private healthcare payers in eight advanced primary care initiatives in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont. The MAPCP demonstration is a multi-payer initiative in which the states arrange the participants and manage the initiatives, instead of the CMS.

The MAPCP examined the success of advanced primary care practices using the following outcomes: clinical quality of care and patient safety, access to and coordination of care, special populations, beneficiary experience with care, patterns of utilization, Medicare and Medicaid expenditures and budget neutrality, according to CMS.

In its first year, the MAPCP demonstration had more than 3,800 participating providers, covering 400,000 Medicare beneficiaries. During this time, approximately $4.2 million was saved.

The results of the MAPCP Demonstration showed that Medicare seamlessly assimilated into existing state programs and MAPCP payments provided much needed support to practices.

“These first year results illustrate the potential for steady improvements in the participating practices’ advanced primary care capabilities. CMS anticipates continued improvements as the participating practices deepen and refine their methods of delivering advanced primary care so that patients can continue to receive improved quality and coordination of care,” Conway said.

For more information:

The CMS Blog. Moving Forward on Primary Care Transformation. Available at: http://blog.cms.gov/2015/01/23/moving-forward-on-primary-care-transformation/. Accessed January 23, 2015.

Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration. Available at: http://innovation.cms.gov/Files/reports/MAPCP-EvalRpt1.pdf. Accessed January 23, 2015.

Evaluation of the Comprehensive Primary Care Initiative: First Annual Report Available at: http://innovation.cms.gov/Files/reports/CPCI-EvalRpt1.pdf. Accessed January 23, 2015.