Year One Updates

First-year Primary Care Project Findings Note Slow, Steady Progress

February 04, 2015 06:03 pm News Staff

Evaluation reports CMS recently released on two of its prominent primary care projects show slow, steady progress on the work.

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In a Jan. 23 blog post(blog.cms.gov) headlined "Moving forward on primary care transformation," CMS Chief Medical Officer Patrick Conway, M.D., shared some first-year findings on initiatives in which family physicians have a big role.

He noted that the Comprehensive Primary Care (CPC) initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) demonstration were "part of broader efforts to deliver better care, spend dollars more wisely and have healthier people and communities."

Conway, who also serves as CMS deputy administrator for innovation and quality, used his blog to trumpet some high notes from the new reports.

For instance, in the first year of the CPC initiative, hospital admissions decreased by 2 percent and emergency department visits decreased by 3 percent.

Story Highlights
  • CMS recently released first-year evaluation reports on two prominent primary care projects: the Comprehensive Primary Care (CPC) initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) demonstration.
  • In the first year of the CPC initiative, hospital admissions decreased by 2 percent and ER visits decreased by 3 percent.
  • The MAPCP demonstration generated about $4.2 million in savings through the use of advanced primary care initiatives designed to promote patient-centered medical home principles.

"In the first year, 492 practices participated, serving about 345,000 Medicare beneficiaries and more than 2.5 million patients overall," wrote Conway. The results suggest that the initiative "has generated nearly enough savings in Medicare health care expenditures to offset care management fees paid by CMS," he added.

Conway said more than 90 percent of practices met first-year practice transformation requirements, but he suggested that more time -- and more data -- were needed to assess the program's impact on the quality of patient care.

He urged stakeholders to interpret results cautiously, but added, "These early results are consistent with the possibility that the model will eventually break even or generate savings."

Conway then turned his attention to the MAPCP demonstration. He noted that in its first year, the project generated about $4.2 million in savings by using advanced primary care initiatives designed to promote patient-centered medical home (PCMH) principles such as access to care, care coordination and patient experience.

The initiative involved more than 3,800 providers in 700 practices. About 400,000 Medicare beneficiaries participated in the first year.

"The rate of growth in Medicare FFS (fee-for-service) health care expenditures was reduced in Vermont and Michigan, driven largely by reduced growth in inpatient expenditures," wrote Conway. However, evidence showing that state initiatives reduced hospitalizations, readmission and emergency department visit rates was less robust.

Thanks to funds provided through the program, practices were able to employ nurse care managers or care coordinators, restructure staff, improve patient flow and implement health information technology.

Conway called the collection and use of health IT data a "recurring challenge" but said technology facilitated the transformation process.

The first-year results from the MAPCP project "illustrate the potential for steady improvements" in primary care practices' ability to deliver high-quality coordinated health care to patients, said Conway.

Digging Deeper: CPC Initiative

The CPC initiative was launched in October 2012 by CMS' Center for Medicare and Medicaid Innovation and was billed as a collaboration between public and private payers. It was designed to improve primary care delivery in seven markets across the United States.

About 1,300 family physicians are participating in the program in Arkansas, Colorado, New Jersey, Oregon, New York, Oklahoma and Ohio.

According to the executive summary of the CPC initiative evaluation report(innovation.cms.gov), participating practices work primarily on achieving milestones involving five functions:

  • access and continuity,
  • planned chronic and preventive care,
  • risk-stratified care management,
  • patient and caregiver engagement, and
  • care coordination.

Report authors suggested that practices "vary considerably in their progress" on successfully implementing components of the initiative. For example, authors noted that practices with previous quality improvement or practice transformation experience were better prepared for success within the CPC initiative.

Practices that received assistance from a regional learning faculty -- services provided in conjunction with the initiative -- said the outside help was a "key contributor" to their practice-level improvement efforts.

The evaluation report also noted challenges practices faced in the first year, including:

  • health IT that couldn't support shared-decision making, risk-stratification documentation, and information sharing across the care management team;
  • lack of direct access to EHRs from physicians in other care settings such as hospitals or subspecialist practices; and
  • reluctance on the part of staff members to engage in changes they considered complex and difficult, including offering patient self-management support and employing risk stratification measures.

Slow, Steady Progress: MAPCP Project

A total of eight states were selected for the MAPCP project. State projects in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont all were operational by Jan. 1, 2012. Although it's clear that many family physicians are involved, participants are not identified by specialty.

According to the evaluation report(innovation.cms.gov), CMS joined state-sponsored initiatives to promote the PCMH concept. Apart from a requirement that the average Medicare payment per patient per month not exceed $10, and that payment methods be applied consistently by all participating payers, each state had leeway to determine its own payment levels and establish its own methodologies.

As for first-year findings, aside from the already noted reduction in the growth rate of Medicare spending in only two of the eight states -- Vermont and Michigan -- authors found little evidence of progress on other fronts, including the ability of state initiatives to reduce utilization rates.

They noted that a reduction in the rate of ER visits in Minnesota was limited to patients who received care from "practices that participated in state pilot activities."

Authors attributed the availability of only limited evidence of project outcomes to a "relatively short" evaluation period.

"Because a strengthening of PCMH capacity, payment reforms and other transformation activities take time to implement and become fully effective, more positive demonstration effects may emerge in the second annual report," they concluded.


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