CMS program will pay management fee to primary care practices

Forty-five insurers from the commercial, state and federal sectors will take part in the Comprehensive Primary Care (CPC) initiative, an effort to improve public health through an emphasis on primary care. The Centers for Medicare & Medicaid Services (CMS) announced the participating payers on June 6.

Set to launch in seven regional and statewide markets, the program has attracted broad-based support from among the nation's largest private payers, including Humana, United HealthCare, Aetna and a number of Blue plans in the selected markets. The program also includes a number of state Medicaid programs and self-insured plans, all of which have signed a Memorandum of Understanding with CMS in order to participate.

"We know that when we support primary care, we get healthier patients and lower costs," said Acting CMS Administrator Marilyn Tavenner, in a prepared statement. "This initiative shows that the public and private sectors can come together to meet the critical need for these services."

Under the program, CMS will pay primary care practices a care management fee, set initially at $20 per member, per month, to support enhanced and coordinated care. At the same time, participating commercial, state and other federal insurance plans will offer an enhanced payment to primary care practices that provide high-quality primary care.

In order to receive the care management fee from CMS and insurers, providers must agree to provide enhanced services for their patients, including offering longer and more flexible hours; using electronic health records; delivering preventive care; coordinating care with patients’ other healthcare providers; engaging patients and caregivers in managing their own care; and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

The program will operate in the following markets: Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley Region, Ohio’s and Kentucky’s Cincinnati-Dayton Region and greater Tulsa, Okla.

WellPoint, which has been bolstering its primary care emphasis in the medical home environment, has affiliated health plans in Colorado, New York and Ohio participating in the program.

“The triple aim in health care is to improve healthcare quality, improve health and reduce healthcare costs. Primary care can have a huge impact on achieving these goals through physician-led care management, better coordination across the system, improved access and shared decision making with patients -- all of which contribute to better engagement, better health outcomes and a more positive healthcare experience for consumers,” said Sam Nussbaum, chief medical officer for WellPoint, in a press release announcing WellPoint’s participation. “Our recently announced patient-centered primary care program builds and expands upon our successful medical home programs and aligns well with CMS’ initiative.”

The next phase of development is for CMS to choose providers within each of the seven markets whose practices are aligned with the goals of program and are focused on improving care through a patient-centered medical home model.

CMS is accepting applications from providers for inclusion in the CPC initiative and envisions eventually as many as 75 providers participating in each of the seven markets.

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