Comprehensive Primary Care Initiative

The CPC Initiative

Led by the CMS Centers for Medicare and Medicaid Innovation (CMMI), the Comprehensive Primary Care initiative (CPC initiative) is a four-year, multi-payer initiative designed to test practice redesign models and a supportive multi-payer payment model.

Under the CPC initiative, CMS will pay selected primary care practices in seven geographic markets a care management fee (initially set at an average of $20 per beneficiary per month) to support enhanced, coordinated services for Medicare beneficiaries in addition to fee-for-service payments.

Simultaneously, participating commercial, state, and other federal insurance plans are offering enhanced payment to primary care practices designed to support them in providing high-quality primary care on behalf of their members. Selected practices may also receive shared savings payment in the later years of the initiative.

Implementing the CPC Initiative

On October 1, 2012, the CPC initiative launched with participating practices in the Arkansas and Oklahoma (Greater Tulsa region) markets with the Oregon, Colorado, Ohio (Cincinnati-Dayton region and Northern Kentucky region), New Jersey, and New York (Hudson-Valley region) markets following on November 1, 2012. This included receipt of initial per member per month (PMPM) payments based on an attribution formula for qualified patients as well as participation in national and local learning collaboratives designed to assist practices in achieving practice redesign.

Five Comprehensive Primary Care Functions and Nine Key 1st Year Milestones

The framework for the CPC initiative set by CMS is designed to achieve the Institute for Health Improvement's Triple Aim of better health, better care, at lower costs.

CMS believes this can be achieved through the provision of comprehensive primary care, including Enhanced Accountable Payment, Continuous Improvement Driven by Data, Optimal Use of Health IT, and implementation of five Comprehensive Primary Care Functions:

  1. Risk-stratified care management
  2. Access and continuity
  3. Planned care for chronic conditions and preventive care
  4. Patient and caregiver engagement
  5. Coordination of care across the medical neighborhood

CMS also created Nine Key 1st Year Milestones they believe will lead practices to successful practice redesign. See a complete list of milestones in the FAQ.