Evaluation of the Comprehensive Primary Care Plus Demonstration

Comprehensive Primary Care Plus is CMS’ latest effort to bolster primary care for beneficiaries.  It builds on earlier demonstrations.  The demonstration is occurring in 18 regions, organizations are supposed to participate for five years and CMS has partnered with other payers to reach more of a provider’s patient base and to provide support for the transformation of the practices.  An evaluation of the first year of the demonstration was recently released.   (CMS Report)   The participating providers are supposed to focus on access and continuity; care management; comprehensiveness and coordination; patient and caregiver engagement and planned care and population health.  There are two tracks providers can choose, in Track 2, the practices are expected to make more changes.  In return for participating, providers get extra payments, with Track 2 participants getting larger ones..  About 2900 primary care practices are participating and over 2 million Medicare beneficiaries are covered, as well as about 12.5 million patients from other payers.   A small number of practitioners and payers dropped out during 2017.

The median additional payment per clinician in 2017 was $32,000 in Track 1 and $53,000 in Track 2; so not insubstantial additional revenue, the bulk of which was paid by Medicare, not the other payers.  Providers had mixed responses to data sharing and learning support, but did say that lessons shared from other practices and coaching tailored to their specific practice were helpful.  The primary actions practices reported taking were risk-stratifying patients, integrating behavioral health and hiring care managers.  93% of practices said participating improved quality of care and 64% said they would participate again.  However, many practices found the IT and other administrative changes overly burdensome and expensive.  As might be expected, the first year of the demonstration was largely devoted to preparing for it and limited impacts on actual outcomes should be expected.  Most practices did report significant progress on meeting the five requirements of the demonstration.  Utilization had very minor improvements in some categories, as did quality metrics.  Costs were higher, because of the additional payments.  The real assessment for this demonstration should be after the full five years.  By then practices should be fully transformed and any cost impacts apparent.