Primary care initiative to commence in seven regions

On April 11, the Centers for Medicare & Medicaid Services (CMS) announced that seven geographic markets have been selected for rollout of the Comprehensive Primary Care Initiative (CPCI). Under the program, Medicare will work with commercial and state health insurance plans and offer bonus payments to primary care physicians who better coordinate care for their Medicare patients.

The CPCI will launch in the states of Arkansas, Colorado, New Jersey and Oregon; the Capital District-Hudson Valley region of New York; the Cincinnati-Dayton region of Ohio; and the greater Tulsa region of Oklahoma.

“The CPCI partners CMS with private-sector insurers to build and expand patient-centered medical home [PCMH] services. Its blended payment of fee-for-service, per-patient-per-month care coordination fee, and shared savings will enable participating primary care practices to build and expand PCMH services with funds to invest in electronic health record technology and redesigned medical offices,” said Glen Stream, MD, president of the American Academy of Family Physicians (AAFP). “The care management fee provides payment for previously uncompensated time for communication with patients, consultants, hospitals and other community resources.”

According to CMS, the participating payers in each market will be entering into a Memorandum of Understanding (MOU) with the agency. Once the participating payers have agreed to the terms and conditions of this MOU, the CMS Innovation Center will 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.

AAFP encourages family physicians in the seven named regions to apply for participation in CPCI once CMS releases the solicitation notice.

“This initiative is key to demonstrating the economic efficacy of care management fees for both Medicare beneficiaries and privately insured patients. By encouraging private-sector insurers to align their payments systems with the CPCI, this effort will enable patients of all ages to receive the comprehensive, coordinated care that is the foundation of the patient-centered medical home: diagnosis and treatment of acute illnesses, preventive services and management of chronic illnesses,” said Stream. “As a result, these patients avoid hospitalizations and emergency department visits, have fewer and less intense treatments, see lower costs and experience a better quality of life.”

You can access a fact sheet on the CPCI here.

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