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Is Primary Care initiative decreasing Medicare spending?

Is Primary Care initiative decreasing Medicare spending?

CMS announced that the Comprehensive Primary Care initiative further decreased Medicare spending and improved quality of care.  

The CPC, a four-year multi-payer program, was launched in October 2012 to help practices in seven regions implement comprehensive primary care. Through the program, participants receive financial support to perform practice transformation and quality improvement activities related to advanced primary care, such as enhanced care coordination, increased access to care and continuity of care, and improved patient engagement.

Participants are paid a monthly non-visit-based care management fee for Medicare fee-for-service beneficiaries and can earn shared savings payments if the Medicare program generates net savings. Participants also demonstrated lower than expected hospital admission and readmission rates as well as improvements in patient experience scores. Most regions, CMS reported, maintained or improved hospital readmissions and admissions rates in the past year for chronic obstructive pulmonary disorder and congestive heart failure.

Patients treated under the initiative also rated CPC practices highly, especially on how practitioners engaged them in their own health and the attention they were given from other providers. In addition, almost all CPC practices reported higher colorectal cancer screening and influenza immunizations rates compared to national benchmarks and all participants reported clinical depression screening rates higher than the national benchmark.

The federal agency also stated that CPC practices exceeded national expectations on electronic clinical quality measures (cCQMs). This was the first year that CMS added eCQM performance as a factor in Medicare shared savings calculations for the initiative.

Initiative Details

The CPC initiative integrates a defined payment model with a specific practice redesign model to support improved care, better health for populations, and lower health costs through improvement:

Payment Model

Participating primary care practices receive two forms of financial support on behalf of their fee-for-service (FFS) Medicare beneficiaries:

  • A monthly non-visit based care management fee
  • The opportunity to share in any net savings to the Medicare program

Participating practices receive a monthly care management fee for each Medicare fee for service (FFS) beneficiary and, in cases where the state Medicaid agency is participating, for each Medicaid FFS beneficiary.

Practices also receive monthly fees from other participating CPC payers and are expected to combine CPC revenues across payers to develop a whole-practice transformation strategy. Additionally, CMS is offering each CPC practice the opportunity to share net savings generated from improved care to Medicare beneficiaries attributable to the practice.

Additionally, CMS is offering each CPC practice the opportunity to share net savings generated from improved care to Medicare beneficiaries attributable to the practice.

 “A robust primary care system is essential to achieve better care, smarter spending, and healthier people. For this reason, CMS is committed to supporting primary care clinicians to deliver the best, most comprehensive primary care possible for their patients.”

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