The Comprehensive Primary Care Initiative: Effects on Spending, Quality, Patients, and Physicians

The Comprehensive Primary Care Initiative: Effects on Spending, Quality, Patients, and Physicians

Published: Jun 30, 2018
Publisher: Health Affairs, vol. 37, no. 6
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Associated Project

Evaluation of the Comprehensive Primary Care Initiative

Time frame: 2012-2023

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services

U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation

Authors

Erin Fries Taylor

Ann S. O'Malley

Timothy J. Day

Grace Anglin

Laura L. Sessums

Randall S. Brown

Key Findings
  • CPC practices reported improved primary care delivery, such as care management for high-risk patients, enhanced access, and improved coordination after care transitions.
  • CPC slowed growth in emergency department visits by 2 percent relative to the comparison group. CPC also slowed growth in hospitalizations by 2 percent relative to the comparison group, though this finding was statistically significant only at the 10 percent level.
  • Similar to the earlier two-year results, Medicare expenditures grew more slowly for the CPC group than for the comparison group; however this change in Medicare expenditures was not enough to offset the initiative’s care management fees.
  • CPC did not appreciably improve or worsen physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures.

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare & Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative’s effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.

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