CMS’ Comprehensive Primary Care Initiative

Last week we reported on the evaluation of early results from the Medicare accountable care organization effort.  At the same time the New England Journal of Medicine carried an analysis of results from the first two years of the Comprehensive Primary Care Initiative, which aims to encourage primary care practices to manage their populations in a thorough manner, with the usual goal of both decreasing spending and improving quality.   (NEJM Article)    Around 500 primary care practices in seven geographic areas are participating in the initiative, which is to last four years.  One distinguishing feature is that CMS is collaborating with private payers for the practices to create a more unified and meaningful approach to improving primary care.  The practices got additional care management fees both from CMS and the private payers.  The practices can also share in any net total savings that CMS experiences and some private payers offered the same sharing.

This analysis used comparison non-participating practices, some in and some outside the demonstration geographic regions.  The analysis looked at how the practices were doing on a scale regarding being an effective primary care medical home, at total Medicare spending, at utilization  and at performance on certain quality of care, continuity of care and experience of care measures.  The practices received fairly hefty additional fees–about $390,000 a practice or 15% of annualized practice revenue.  It appeared that most practices increased their scores on being a medical home, particularly in regard to access to care and risk-stratified care management.  Without taking into account the care management fees, spending per beneficiary in the initiative practices declined slightly, after taking the fees into account, they increased slightly, in both cases in comparison to the control practices and in both cases the difference was not statistically significant.  There was some regional variation in the results.  Utilization was generally the same between initiative and comparison practices–hospital use was similar, there were slightly fewer primary care visits for the initiative practices, which is not what would be expected.  Quality measure performance was generally similar, but for high-risk patients with diabetes, the initiative practices made much more significant quality gains than did the comparison practices.  There were small comparative gains in patient experience of care.  It is only two years in, but so far, no spending reductions and little quality gain.