CPC initiative 'transforming' care delivery, not yet providing savings, improved quality

After 2 years, medical practices participating in the Comprehensive Primary Care initiative, spearheaded by CMS in 2012 to test new payment and care methods over a period of 4 years, has yet to show savings in expenditures for Medicare parts A and B after accounting for care-management fees, according to data published in the New England Journal of Medicine.

The researchers for the CMS-funded study further concluded that participating practices have also not seen an “appreciable improvement” in the quality of care or patient experience. However, they added that the practices have, after 2 years, seen progress in transforming the delivery of primary care.

“Fee-for-service payments give providers the incentive to favor volume over value in the delivery of health care and can produce fragmented care that often lacks coordination, is not patient-centered, and is not proactive in population health management,” Stacy B. Dale, MPA, of Mathematica Policy Research, in Chicago, and colleagues wrote. “… In October 2012, the CMS, in collaboration with 39 private and public payers launched the Comprehensive Primary Care initiative.”

CMS debuted the Comprehensive Primary Care initiative (CPC) in seven regions across the United States, with the goal of improving quality and reducing costs. The 502 participating practices were required to changes to make changes to care delivery, all intended to improve performance in five areas: Access to and continuity of care, planned care for preventive and chronic needs, risk-stratified care management, engagement of patients and their caregivers, and coordination of care with patients’ other care providers.

To assess the effects of CPC on Medicare expenditures, the use of services, selected quality-of-care measures and patient experience during the initiative’s first 2 years, the researchers tracked changes in the delivery of care and used difference-in-differences regressions among the 497 practices still enrolled in the program — five practices had dropped out after reviewing the terms and conditions of participation. Researchers compared changes over the first 2 years of the initiative in Medicare expenditures, health care use, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of 908 comparison practices.

According to the researchers, practices enrolled in the initiative received a median of $115,000 per clinician in care-management fees during CPC’s first 2 years. In addition, the practices reported improvements in approaches to the delivery of primary care, including management of the care of high-risk patients and enhanced access to care. However, changes in the average monthly Medicare expenditures per beneficiary did not differ significantly between CPC and comparison practices, whether care-management fees were not taken into account (–$11; 95% CI, –23 to 1), or were ($7; 95% CI, –5 to 19).

The only significant differences in other measures were a 3% reduction in primary care visits for CPC practices relative to comparison practices (P < .001), and small improvements in two of the six domains of patient experience — discussion of decisions regarding medication with patients (P = .006) and the provision of support for patients taking care of their own health (P < .001).

“Our results suggest that initiative practices are transforming care delivery,” Dale and colleagues wrote. “However, midway through the intervention, relative to comparison practices, the initiative has not yet generated savings in Medicare parts A and B expenditures that are sufficient to cover care-management fees. The 3% reduction in primary care visits, albeit a small contributor to total expenditures, suggests that nonbillable calls, emails, and interactions related to care management, supported by initiative fees, may have supplanted or reduced the need for office visits.” – by Jason Laday

Disclosure: Dale reports receiving a grant from CMS while conducting the study. See the full study for additional researchers’ disclosures.