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Medicare News

Medicare to Pay Bonuses to Primary Care Doctors for Better Care, Efficiency

Comprehensive Primary Care initiative modeled after private health insurers

Sept. 29, 2011 - A new initiative to help primary care physicians deliver higher quality, more coordinated and patient-centered care to Medicare patients, was launched yesterday, according to Health and Human Services. Medicare will work with commercial and state health insurance plans to offer additional support to primary care doctors who better coordinate care for their patients.

Medicare Enrollment Opens Oct. 15 - Ends Dec. 7, 2011

This collaboration, known as the Comprehensive Primary Care initiative, is modeled after innovative practices developed by large employers and leading private health insurers in the private sector.

“Thanks to the Affordable Care Act, we are helping primary care doctors better coordinate care with patients so they get better care and we use our health care dollars more wisely,” said HHS Secretary Kathleen Sebelius.

The voluntary initiative will begin as a demonstration project available in five to seven health care markets across the country. Public and private health care payers interested in applying to participate in the Comprehensive Primary Care Initiative must submit a Letter of Intent by November 15, 2011. In the selected markets, Medicare and its partners will enroll interested primary care providers into the initiative.

 

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Primary care practices that choose to participate in this initiative will be given support to better coordinate primary care for their Medicare patients.
This support will help doctors:

   ● Help patients with serious or chronic diseases follow personalized care plans;

   ● Give patients 24-hour access to care and health information;

   ● Deliver preventive care;

   ● Engage patients and their families in their own care;

   ● Work together with other doctors, including specialists, to provide better coordinated care.

The Centers for Medicare & Medicaid Services (CMS) will pay primary care practices a monthly fee for these activities in addition to the usual Medicare fees that these practices would receive for delivering Medicare covered services.

“This collaborative approach has the potential to strengthen the primary care system for all Americans and reduce health care costs by using resources more wisely and preventing disease before it happens,” according to the HHS news release.

“Across the country, systems which are based on comprehensive, higher-functioning primary care, similar to the strategy that CMS seeks to test in this initiative, show that patients are healthier and avoid having to seek care in more complex and expensive settings when primary care practices have the resources to better coordinate care, engage patients in their care plan, and provide timely preventive care.

“Large businesses have been able to make independent investments to promote more comprehensive primary care – improving the health of their employees and lowering their health care costs, thus making it easier for them to hire more workers and invest in their workforce.

CMS Administrator Donald Berwick, M.D., added “We know that when doctors have time to spend time with their patients and can better coordinate care with specialists, people are healthier and we have lower costs in the health care system.”

The Comprehensive Primary Care initiative is just one part of a wide-ranging effort by the Obama Administration to promote coordinated care and lower costs for all Americans, using important new tools provided by the Affordable Care Act, according the HHS.

Accountable Care Organizations (ACOs) are another way that doctors, hospitals and other health care providers can work together to better coordinate care for patients, which can help improve health, improve the quality of care, and lower costs.

Under the Bundled Payment initiative, payments for multiple services patients receive during an episode of care will be linked to help improve and coordinate care for patients while they are in the hospital and after they are discharged.

The Partnership for Patients is bringing together hospitals, doctors, nurses, pharmacists, employers, unions, and state and federal government to keep patients from getting injured or sicker in the health care system and to improve transitions between care settings.

For more information:

>> the Comprehensive Primary Care initiative web site.

>> For an overview fact sheet about the Comprehensive Primary Care initiative.

Interested parties may obtain answers to specific questions by e-mailing CMS at: CPCi@cms.hhs.gov.

>> For more information about the CMS Innovation Center

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