Comprehensive Primary Care Initiative

Recent Updates:

05/08 - Eligibility information for Primary Care Practices posted
04/11 - Seven selected geographic markets posted

The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.

Selected Markets

On April 11, 2012, the CMS Innovation Center announced from a pool of applicants, the following areas to represent selected markets. These markets are multi-payer and may include private health plans, state Medicaid agencies, and employers:

Arkansas: Statewide
Colorado: Statewide
New Jersey: Statewide
New York: Capital District-Hudson Valley Region
Ohio: Cincinnati-Dayton Region
Oklahoma: Greater Tulsa Region
Oregon: Statewide

The participating payers in each market will be entering into a Memorandum of Understanding with CMS. Once the participating payers in each market have agreed to the terms and conditions of this MOU, the Innovation Center will then release a solicitation to primary care practices in these geographic areas wishing to participate in providing comprehensive primary care as part of this initiative. Approximately 75 primary care practices in each designated market will be selected to participate.

Primary Care Practices: Eligibility and How to Apply

In June 2012, the CMS Innovation Center will release the application for primary care practices to participate in the CPC initiative to test a new service delivery and payment model of high value primary care. This model will support practices providing comprehensive services to patients on whose behalf they will receive enhanced payment from Medicare and other participating payers, which may include state Medicaid agencies and commercial health plans.

The CPC initiative will be accepting applications from individual primary care practice sites that are geographically located in the above selected markets. If your primary care practice has multiple sites, each physical site that is located in the selected market is eligible to apply and must apply separately.

Check your eligibility to apply for participation here. Upon completing the check, all eligible applicants will receive an email with further details about the upcoming application and how to apply to the program.

Background

Primary care is critical to promoting health, improving care, and reducing overall system costs, but it has been historically under-funded and under-valued in the United States. Without a significant enough investment across multiple payers, independent health plans-- covering only their own members and offering support only for their segment of the total practice population-- cannot provide enough resources to transform entire primary care practices and make expanded services available to all patients served by those practices.

A primary care practice is a key point of contact for patients’ health care needs. In recent years, new ways have emerged to strengthen primary care by improving care coordination, making it easier for clinicians to work together, and helping clinicians spend more time with their patients. All around the country, health care providers and health plans have taken the lead in investing in primary care. Employers across the country have found that with health coverage policies that emphasize primary care, coordinated care, and other strategies that keep their employees healthy, they not only support a healthier workforce, they create a healthier bottom line.

The Comprehensive Primary Care Initiative will build on these and other efforts.

Initiative Details

The CPC initiative offers a way to break through this historical impasse by inviting payers to join with Medicare in investing in primary care in 5-7 selected localities across the country. The resources will help doctors work with patients to ensure they:

Manage Care for Patients with High Health Care Needs: Patient with serious or multiple medical conditions need more support to ensure they are getting the medical care and/or medications they need. Participating primary care practices will deliver intensive care management for these patients with high needs. By engaging patients, primary care providers can create a plan of care that uniquely fits each patient’s individual circumstances and values.
Ensure Access to Care: Because health care needs and emergencies are not restricted to office operating hours, primary care practices must be accessible to patients 24/7 and be able to utilize patient data tools to give real-time, personal health care information to patients in need.
Deliver Preventive Care: Primary care practices will be able to proactively assess their patients to determine their needs and provide appropriate and timely preventive care.
Engage Patients and Caregivers: Primary care practices will have the ability to engage patients and their families in active participation in their care.
Coordinate Care Across the Medical Neighborhood: Primary care is the first point of contact for many patients, and takes the lead in coordinating care as the center of patients’ experiences with medical care. Under this initiative, primary care doctors and nurses will work together and with a patient’s other health care providers and the patient to make decisions as a team. Access to and meaningful use of electronic health records should be used to support these efforts

The CPC initiative will test two models simultaneously: a service delivery model and a payment model:

Service Delivery Model
The service delivery model will test comprehensive primary care, which is characterized as having the following five functions:

Risk-stratified Care Management;
Access and Continuity;
Planned Care for Chronic Conditions and Preventative Care;
Patient and Caregiver Engagement;
Coordination of Care Across the Medical Neighborhood.

Payment Model
The payment model includes a monthly care management fee paid to the selected primary care practices on behalf of their fee-for-service Medicare beneficiaries and, in years 2-4 of the initiative, the potential to share in any savings to the Medicare program. Practices will also receive compensation from other payers participating in the initiative, including private insurance companies and other health plans, which will allow them to integrate multi-payer funding streams to strengthen their capacity to implement practice-wide quality improvement.

Additional information

For more information, please send your questions to CPCi@cms.hhs.gov.