Policy & Regulation News

CPC Initiative Improves Care Delivery But Not Medicare Spending

The Comprehensive Primary Care initiative produced improvements in care delivery but not in Medicare spending, quality of care or patient experience.

By Catherine Sampson

- Although the Comprehensive Primary Care (CPC) initiative lead to progress in primary care delivery, it has not caused improvements in Medicare spending, patient experience or quality of care, researchers from The New England Journal of Medicine found.

The Comprehensive Primary Care initiative caused improvements in care deliver, but not in Medicare spending.

“Our results suggest that initiative practices are transforming care delivery,” researchers said. “However, the initiative has not yet generated savings in Medicare Part A and B expenditures that are sufficient to cover care-management fees.”

The CPC initiative clearly lead to a few positive changes, but perhaps not as many as policy makers would like to see. It produced enhanced access to care and improvements in the management of care for high-risk patients, researchers said, and specifically lead to a three-percent reduction in primary care visits.

Non-billable calls, emails, and interactions related to care management, which were supported by initiative fees, may have caused the reduction in visits.

  • CMS Expects to Release MIPS Participation Status By May 2017
  • Administration Invests $1.5B to Address Healthcare Workforce Shortage
  • High Hospital Prices Do Not Always Lead to Better Health Outcomes

    • The study observed that the initiative did not significantly impact other measures, such as how well providers communicated with patients and patients wait times. Also, the number of hospitalizations did not change significantly.

    Practices also did not experience significant savings in Medicare Part A and B expenditures. Researchers saw no significant differences in the growth of expenditures, without or with the inclusion of care-management fees.

    The study indicated a few possible reasons why these findings were not more favorable. “First, practices may need more time to fully implement changes in care delivery that translate to improved outcomes,” researchers said.

    Also, because many practices were “not necessarily attuned to the details of shared savings,” more time might be needed for the incentive of shared savings to influence care delivery. Primary care practices might also need stronger value-based incentives.

    Although the research team did not see improvements in hospital admissions and expenditures, previous research from CMS revealed positive changes in these areas.

    According to a previous report, the Comprehensive Primary Care initiative lead to a decrease in hospital admissions by two percent and emergency department visits by three percent. These factors contributed to a reduction of expenditures that were almost enough to offset care management fees paid by CMS.

    Also, other researchers have seen promising, yet mixed results from the initiative. “Across all seven regions in the first year, early results suggest that CPC has generated enough savings in Medicare health care expenditures to nearly cover the CPC care management fees paid by CMS for attributed Medicare fee-for-service beneficiaries, although not enough to generate net savings,’ Mathematica Policy Research stated in a report.

    CPC is intended to reduce Medicare fee-for-service expenditures by reducing patients’ need for high-cost services such emergency department visits and hospitalization. It’s possible that the initiative yielded more positive results in its first year than in its second.

    In 2012, a four-year multiplayer CPC Initiative was launched by CMS and 39 other payers as a way to determine if several forms of support could improve care delivery and reduce costs. “Support included the provisions of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support,” The New England Journal of Medicine said.

    The initiative was intended to test a new approach to the payment and delivery of primary care for four years in seven regions across the US. During the first two years of the initiative, participating practices received a median of $115,000 per clinician in care-management fees, the study said.

    The initiative has a core set of comprehensive primary care functions, which include risk-stratified care management, access and continuity, patient and caregiver engagement and coordination of care. “Annually, beginning in year 2, practices were eligible to share in any Medicare fee-for-service savings resulting from reduced total expenditures, including care-management fees.” CMS said.

    Dig Deeper: