Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

CMS Announced Success of Primary Care Transformation Pilots

By Ryan Mcaskill

The success of two pilot programs that focus on primary care transformation has CMS hopeful for prolonged change.

- To meet the quickly changing healthcare landscape, a number of organizations are running pilot programs to experiment with new payment and care delivery models that can cut costs and improve the quality of care patients receive. When these pilot programs are successful, they enter the next phase and get a more wider implementation.

This week, Dr. Patrick Conway, Centers for Medicare and Medicaid Services (CMS) Deputy Administrator for Innovation and Quality and Chief Medical Officer wrote a blog post for CMS that touts the promising results from two pilot programs that aim to transform primary care. They are the Comprehensive Primary Care (CPC) initiative and the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration.

“Today, CMS are excited to announce the promising findings from two large-scale tests of advanced primary care,” Dr. Conway wrote. “The CPC initiative, in its first year, decreased hospital admissions by 2 percent and emergency department visits by 3 percent, contributing to the reduction of expenditures nearly enough to offset care management fees paid by CMS. The MAPCP Demonstration generated an estimated $4.2 million in savings through the use of advanced primary care initiatives.”

The CPC initiative is a unique multi-payer partnership between Medicare, Medicaid private healthcare payers and primary care practices in four states (Arkansas, Colorado, New Jersey and Oregon) and three regions (New York’s Capital District and Hudson Valley, Ohio and Kentucky’s Cincinnati-Dayton region, and Oklahoma’s Greater Tulsa region). Over the first year, 492 practices participated that serve 345,000 Medicare beneficiaries and more than 2.5 million patients overall.

The goal of the initiative is to provide care management for those at greater risk, improve access, track patient experiences, coordinate care and use health information technology to support population health. Practices received non-visit based reimbursement from participating payers and have the chance to share the savings.

The main cost saving method is a reduction in hospital admissions and emergency department visits, especially when it comes to higher-risk patients. Over 90 percent of participating practices were able to successfully meet all transformation requirements.

The MAPCP Demonstration is a multi-payer initiative in which Medicare is participating with Medicaid and private healthcare payers in eight advanced primary care initiatives. These were run in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont. Participating practices receive monthly care management fees from the participating payers and additional support like data feedback and practice coaching.

In the first year, more than 3,800 providers, 700 practices and 400,000 Medicare beneficiaries participated. Medicare was able to seamlessly integrate with the eight states and it was clear that MAPCP payments providers would need support to help practices transform the way they deliver coordinated care.

“These first-year results illustrate the potential for steady improvements in the participating practices’ advanced primary care capabilities,” Dr. Conway wrote. “CMS anticipates continued improvements as the participating practices deepen and refine their methods of delivering advanced primary care so that patients can continue to receive improved quality and coordination of care.”



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