The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians

Abstract

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.

Association between GP participation in a primary care group and monitoring of biomedical and lifestyle target indicators in people with type 2 diabetes: a cohort study (ELZHA cohort-1)

“…In the USA, the CPC initiative has key characteristics in common with the Dutch care group approach. Our findings show a greater increase in monitoring than found in the evaluation of the first year CPC24–26 which detected only small improvements in monitoring. This difference might be explained by the recent introduction of the CPC programme, since an in-depth evaluation of US practices participating in the CPC programme revealed that practice staff appreciated advice adjusted to their job roles and practice organisation, and the electronic health record system and other digital systems used in their practice27—indicating that a quality transition had been initiated.…”

Practice Transformation Analytics Dashboard for Clinician Engagement

“…Recent studies report that although transformation of practices creates additional work-including team building, data collection, reporting, and management-this work does not contribute to burnout. [14][15][16] Data on patient and family engagement were included in the dashboard to highlight essential elements to success in developing therapeutic relationships with patients. Although patient and family advisory boards were not popular because of staffing challenges and time requirements, all practices were likely to include patient feedback in operations using patient portals, direct feedback, comment cards, and suggestion boxes.…”

Development, Value, and Implications of a Comprehensive Primary Care Payment Calculator for Family Medicine

“…While improvements have been noted in terms of access, delivery of care to high-risk populations and decreased emergency department visits, the program is currently slated to end in 2019. 9 CPCP provides one possible transition path for clinics and systems, such as those involved in CPC+, that have begun a transition away from FFS.…”