Primary care practices to test service delivery and payment model


A service delivery and payment model, operating under the Centers for Medicare & Medicaid Services (CMS)'s Comprehensive Primary Care Initiative, will be tested this fall by 500 primary care practices in seven U.S. regions. The selected practices will be working in partnership with CMS, state agencies, commercial health plans and self-insured businesses to improve access to quality care and lower costs.

CMS will pay providers a care management fee, initially an average of $20 per beneficiary per month, to support enhanced, coordinated services for Medicare fee-for-service patients. As the program matures, the practices have the potential to share in any savings to the Medicare program.

At the same time, participating commercial, state and other federal insurance plans will also offer increased payment to the practices to deliver quality primary care to their members, according to a CMS announcement released Aug. 22.

For patients, it means that these physicians may offer longer and more flexible hours; use EHRs; coordinate care with patients’ other health care providers; better engage patients and caregivers in managing their own care; and provide individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

Practices were selected based on their use of health IT; ability to demonstrate recognition of advanced primary care delivery by leading clinical societies; service to patients covered by participating payers; participation in practice transformation and improvement activities; and diversity of geography, practice size, and ownership structure.

Practices must also be accessible to patients 24/7 and be able to use patient data tools to give real-time, personal healthcare information to patients who want it.

Practices in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley region, Ohio and Kentucky’s Cincinnati-Dayton region, and the Greater Tulsa region of Oklahoma signed letters of intent with CMS to participate in the initiative. The practices represent 2,144 providers serving 313,000 Medicare beneficiaries.

“Primary care practices play a vital role in our healthcare system, and we are looking at ways to better support them in their efforts to coordinate care for their patients,” said Marilyn Tavenner, acting CMS administrator, in a statement.

The project is a four-year initiative of the CMS Innovation Center.