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Medicare News

Players Set for Better Health Care at Lower Cost in CMS Primary Care Initiative

Public-private partnership ready to begin helping Medicare patients in 7 regions of U.S.

Aug. 22, 2012 – An initiative designed in 2011 to provide improved access to quality health care at lower costs for Medicare patients has completed signing up 500 primary care practices. The Centers for Medicare & Medicaid Services says the Comprehensive Primary Care Initiative begins this fall to provide “more effective, more affordable, higher quality health care.”

The primary care practices were selected in seven regions of the U.S. to participate in this partnership between payers including CMS, state Medicaid agencies, commercial health plans, self-insured businesses, and primary care providers.

 

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Under the Comprehensive Primary Care Initiative, 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.

This initiative will also provide practices serving people with Medicaid with additional support to allow them to participate.

CMS estimates that over 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.

For patients, this means these physicians may 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 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 the following areas:
   ● 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.

The participants 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.

The Comprehensive Primary Care 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.

For more information, please go to: http://www.innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative

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