Through the CPC program, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state, and other federal insurance plans are also offering enhanced payment to primary care practices that are designed to support them in providing high-quality primary care on behalf of their members.
“WellPoint and CMS are aligned in our commitment to help improve the accessibility and affordability of quality health care for Americans, and we believe the CPC initiative represents a significant means by which we will achieve this,” said Dr. Harlan Levine, executive vice president of Comprehensive Health Solutions for WellPoint. “Primary care is the foundation of good medicine, and it should be the foundation for patient health. We are pleased that many of the physicians who participate with our health plans have been chosen for this pioneering initiative that will help improve care and reduce unnecessary costs.”
For patients, the CPC initiative means participating physicians are encouraged to offer longer and more flexible hours; use electronic health records; 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.
“The Comprehensive Primary Care initiative is the kind of common-sense investment in health care we need,” said Health and Human Services Secretary Kathleen Sebelius. “Businesses, families, and taxpayers all benefit from a stronger primary care system that helps to improve our health and lower costs.”
The initiative started in the fall of 2011 with CMS soliciting a diverse pool of commercial health plans, state Medicaid agencies, and self-insured businesses to work alongside Medicare to support comprehensive primary care. Public and private health plans 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 this initiative. The markets were selected in April, 2012 based on the percentage of the total population covered by payers who expressed interest in joining this partnership.
Eligible primary care practices in each market were invited to apply to participate and start delivering enhanced health care services in the fall of 2012. Through a competitive application process, primary care practices within the selected markets were chosen to participate in the Comprehensive Primary Care initiative. Practices were chosen based on their use of health information technology, 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. CMS estimates that more than 300,000 Medicare beneficiaries will be served by over 2,000 providers through this initiative.
“Primary care practices play a vital role in our health care system and we are looking at ways to better support them in their efforts to coordinate care for their patients,” said Acting CMS Administrator Marilyn Tavenner. The CPC initiative aligns and shares a foundation with WellPoint’s patient-centered primary care initiative to significantly strengthen the role of primary care through added financial incentives and resources. WellPoint announced its program earlier this year and has worked closely with CMS and others on the CPC effort. The CPC initiative is a four-year initiative administered by the Center for Medicare and Medicaid Innovation (CMS Innovation Center). The CMS Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care.