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The Centers for Medicare and Medicaid Services (CMS) has selected 500 primary care practices in seven regions around the country to participate in a partnership with CMS, state Medicaid agencies, commercial health plans and self-insured businesses, with the aim of improving access to quality care and lowering costs.
CMS chose practices in part on their adoption of electronic health records (EHRs) and other health IT.
Under the Comprehensive Primary Care Initiative, CMS will test a service delivery model and payment model.
CMS will pay providers a care management fee, initially an average of $20 per beneficiary per month, to support enhanced, coordinated services for Medicare fee-for-service patients. As the program matures, the practices have the potential to share in any savings to the Medicare program.
The providers will start delivering the enhanced services in the fall, according to an Aug. 22 CMS announcement.
At the same time, participating commercial, state, and other federal insurance plans will also offer increased payment to the practices to deliver quality primary care to their members.
For patients, it means that these physicians may offer longer and more flexible hours, use EHRs; coordinate care with patients’ other health care providers; better engage patients and caregivers in managing their own care, and provide individualized, enhanced care for patients living with multiple chronic diseases and higher needs.
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Practices were selected based on their use of health IT, ability to demonstrate recognition of advanced primary care delivery by leading clinical societies, service to patients covered by participating payers, participation in practice transformation and improvement activities, and diversity of geography, practice size, and ownership structure.
Practices must also be accessible to patients 24/7 and be able to use patient data tools to give real-time, personal healthcare information to patients who want it.
The primary care providers are in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley region, Ohio and Kentucky’s Cincinnati-Dayton region, and the Greater Tulsa region of Oklahoma signed letters of intent with CMS to participate in this initiative. The practices represent 2,144 providers serving 313,000 Medicare beneficiaries.
“Primary care practices play a vital role in our healthcare system, and we are looking at ways to better support them in their efforts to coordinate care for their patients,” said Marilyn Tavenner, acting CMS administrator, in a statement.
The Comprehensive Primary Care initiative is a four-year initiative of the Center for Medicare and Medicaid Innovation (CMS Innovation Center).