New findings from the second annual report of Mathematica’s independent evaluation of Comprehensive Primary Care Plus (CPC+), the largest and most ambitious primary care and delivery reform ever tested in the United States, show CPC+ continued to provide primary care practices with substantial supports and required practices to make advanced care delivery changes. In the second year of the five-year evaluation, researchers found that CPC+ practices built on their progress from the first year to make important changes in care, such as providing care management to high-risk patients, further integrating behavioral health care into their practices, and establishing formal processes with hospitals and emergency departments to improve care transitions. However, as expected at this stage of making changes to care delivery, there were few effects on cost, service use, and quality for Medicare fee-for-service (FFS) beneficiaries.
CPC+ is a national, advanced primary care medical home model developed by the Centers for Medicare & Medicaid Services (CMS) that aims to strengthen primary care through regionally based multi-payer payment reform and care delivery transformation. For this study, Mathematica is collaborating closely with CMS to assess whether CPC+ achieves its goal of increasing access to—and improving the quality and efficiency of—primary care, which ultimately is intended to achieve better health outcomes at lower costs. The evaluation will also examine whether CPC+ enhances primary care physicians’ experience. The research builds on Mathematica’s evaluation of the Comprehensive Primary Care (CPC) initiative, known as “CPC Classic.”
The report and an accompanying fact sheet and a webinar describe findings from our evaluation of the second year of CPC+. The research looked at the first two years of CPC+ implementation for the 2,905 practices that started CPC+ in 2017. The evaluation also examined the effects of these practices’ work in the first two years on expenditures and service use and on the patient experiences of Medicare FFS beneficiaries. In addition, it looked at the first program year for practices that joined CPC+ in 2018, and found that the experiences and results were similar to the first-year experiences and results of practices that started in 2017.
“The second-year evaluation findings show primary care practices are doing the hard work to improve care delivery for their patients, but we’re still in the early stages of the evaluation,” said Deborah Peikes, project director and senior fellow at Mathematica. “We may find that effects on patient outcomes emerge with more time, as CPC+ practices deepen and expand care delivery changes.”
Key findings from the second year include:
- In the second year, CPC+ continued to provide practices that started in 2017 with significant supports. CMS and payer partners provide CPC+ practices with enhanced and alternative payments. These included additional payments in the second year that were over and above what the practices receive for traditional services: a median of $122,000 to Track 1 practices and $263,000 to Track 2 practices, which are required to implement more advanced care delivery changes for patients with complex needs. CMS and one-fifth of payers also shifted a portion of payments for traditional services away from the FFS model (which incentivizes volume of services) to prospective payments. In addition, practices received data feedback, individualized and group learning supports, and health IT vendor support. They used the CPC+ supports to make beneficial changes to care delivery, but many practices indicated that additional payments, more timely and user-friendly data feedback, and stronger health IT support would be helpful in achieving the aims of CPC+.
- CPC+ practices continued to change care delivery in 2018. In the second year of CPC+, practices continued to actively embrace the hard work of implementation, focusing on care management, behavioral health integration, and planned care and population health.
- As in the first year of CPC+, practices acknowledged that their transformation work improved the quality of care they provide, but they found aspects challenging. Practices have additional work to do to more fully integrate new services into their workflows and offer new services to more patients who could benefit.
- Primary care transformation takes time to implement. For Medicare FFS beneficiaries, CPC+ had a few, very small favorable impacts on service use and quality of care in the first two years. However, CPC+ slightly increased expenditures for these beneficiaries and increased net costs by 2 to 3 percent, when including the enhanced payments CMS made to practices.