The Medicare Comprehensive Primary Care Initiative

The Comprehensive Primary Care Initiative was started in October 2012 by CMS to attempt to improve primary care, with the hope that quality scores would rise and spending sink.  Other payers joined the Initiative in an attempt to have it cover more patients and be more meaningful to an individual physician’s practice.  An interim evaluation after two years showed no real improvement in any outcomes, but that may have been two short a time for changes to be fully implemented and show an effect.  Alas, the four-year evaluation, just published in Health Affairs, doesn’t look much better.   (HA Article)   The main things that providers were supposed to do better were care coordination with other providers, patient engagement, risk-stratified care management, enhanced access to and continuity of care and focus on chronic conditions.  Participants got paid more, got training and support and received data and feedback.  They had the opportunity to share in spending savings.  There were 497 participating practices in seven geographic regions.  The performance of these practices over the four-year period was compared with that of matched non-participating practices.

The practices generally did a good job of changing their activities to focus on the primary care areas identified by the initiative.  But implementing those changes appeared to do little for outcomes.  Spending growth in the study period was slightly less for the participating practices, if the extra fees weren’t considered, but slightly more if they were.  There was non-statistically significant, slightly lower inpatient and primary care use in the participating practices.  There was a slight, but statistically significant, decline in ER use.  Quality of care measures also showed no significant difference between the two sets of practices.  There was little difference in patient experience with care measures, except for better followup after hospitalization and ER use.  Physicians reported very positive experience with the initiative.  Theories on why their wasn’t more of a change in outcomes range from the need for stronger financial incentives to general changes across the entire health system that led to better primary care everywhere.  Some providers also identified cost and other barriers to fully implementing the changes.  Better primary care is a worthy objective, but it may not reduce spending or improve quality as much as we would like.