New findings from Mathematica’s independent evaluation of Comprehensive Primary Care Plus (CPC+) show CPC+ continued to provide primary care practices with substantial supports and required practices to make more advanced changes to care delivery. CPC+ is the largest and most ambitious primary care payment and delivery reform ever tested in the United States. In 2019, the third year of the five-year evaluation, researchers found that CPC+ practices built on their progress in the first two years to make important changes in care, such as providing care management to high-risk patients and integrating behavioral health care into their practices. As expected at this stage of the initiative, there were a few small, favorable effects on some measures of service use, quality of care, and patient experience for Medicare fee-for-service (FFS) beneficiaries. However, enhanced payments to CPC+ practices from the Centers for Medicare & Medicaid Services (CMS) increased CMS’s expenditures for Medicare beneficiaries.
CPC+ is a national model for advanced primary care that CMS developed to strengthen primary care through regional multipayer 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 primary care, improving its quality and efficiency, and ultimately, achieving better health outcomes at a lower cost. The evaluation also examines whether CPC+ enhances primary care physicians’ experiences. The research builds on Mathematica’s evaluation of the Comprehensive Primary Care (CPC) initiative, known as CPC Classic.
The report and accompanying Findings at a Glance describe the results of our evaluation of the third year of CPC+. The research looks at the first three years of CPC+ implementation for the 2,905 practices that started CPC+ in 2017. It also examines the effects of the practices’ first three years of work on expenditures, service use, quality, and patient experiences for Medicare FFS beneficiaries.
“The third-year evaluation findings show primary care practices are working hard to improve care delivery for their patients,” said Deborah Peikes, project director and senior fellow at Mathematica. “We found reductions in hospitalizations emerged in the fifth year after transformation and continued through the sixth year for practices in the predecessor model, CPC Classic. We might find that the effects of CPC+ on patient outcomes emerge with more time, as CPC+ practices deepen and expand care delivery changes.”
Key findings from the third year included the following:
- In the third year, CPC+ continued to provide practices with significant supports. CMS and payer partners provide CPC+ practices with enhanced and alternative payments. These included additional payments in the third year beyond what practices receive for traditional services. Track 1 practices received a median of $136,201, and Track 2 practices, which are required to implement more advanced changes to care delivery for patients with complex needs, received a median of $268,560. CMS and one-sixth of payer partners also shifted a portion of payments for traditional services away from the FFS model (which incentivizes volume of services) to prospective payments. Practices also received data feedback, individualized and group learning supports, and health information technology (IT) vendor support. Practices used CPC+ supports to make beneficial changes to care delivery. However, they found health IT less useful than payment, data feedback, and learning supports.
- CPC+ practices continued to work to improve care delivery in 2019 but found some aspects challenging. In the third year of CPC+, practices continued to embrace the hard work of implementing the model, focusing on care management, behavioral health integration, and using data to continuously improve patients’ health, experience, and quality of care. But practices have additional work to do on the more challenging CPC+ requirements, such as offering alternatives to traditional office visits and offering longitudinal care management to more patients. Still, practices continued to be satisfied with their decision to join CPC+.
- Primary care transformation takes time to implement. For Medicare FFS beneficiaries, CPC+ had a few, small favorable impacts on service use, quality of care, and patient experience in the first three years. However, when including CMS’s enhanced payments, CPC+ increased CMS’s expenditures for these beneficiaries by 2 percent in Track 1 and 3 percent in Track 2.
Future evaluation reports will continue to track model progress and whether the small favorable effects of CPC+ on Medicare FFS beneficiaries grow as participating practices continue to implement CPC+. This report presents findings from CPC+ in 2019; the effect of the COVID-19 pandemic on CPC+ and comparison patients’ use of health care services, practices, and physicians will be a key focus of the next report.