Primary Care Makes Strides in Improving Quality and Costs

Dr. Patrick ConwayBy Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer

Today, the Centers for Medicare & Medicaid Services (CMS) announced promising results of the first shared savings performance year for the Comprehensive Primary Care (CPC) initiative. This model is part of our broader effort at CMS to promote better care, smarter spending, and healthier people.

In 2014, CPC practices showed positive quality results, with hospital readmissions lower than national benchmarks and high performance on patient experience measures, particularly on provider communication with patients and timely access to care. CPC practices that demonstrated high quality care and reduced spending above a threshold shared in savings generated for Medicare.

During this first shared savings performance year, the initiative decreased Medicare Part A and Part B spending compared to spending targets while achieving high quality outcomes. The CPC initiative generated a total of $24 million in gross savings overall (excluding the CPC care management fees). These results reflect the work of 483 practices that served approximately 377,000 people with Medicare and more than 2.7 million patients overall. Four of the CPC initiative’s seven regions (Arkansas, Colorado, Cincinnati-Dayton region of Ohio, and Oregon) generated gross savings. The Greater Tulsa region decreased costs in excess of the CPC care management fees, generating net savings of $10.8 million and earning more than $500,000 in shared savings payments.

Quality highlights from the first shared savings performance year include:

  • Over 90 percent of CPC practices successfully met quality targets on patient experience (as determined by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys) and utilization (hospital admission and readmission) measures, indicating quality scores that matched or exceeded national comparisons.
  • All regions had lower-than-targeted hospital readmission rates. Readmissions can be burdensome to patients and caregivers and costly to the healthcare system. Lower readmissions indicate better coordination of care during transitions and patient support during the post-discharge period.
  • Patients receiving care from CPC practices scored their primary care practitioners highly, particularly on how well clinicians communicate and on getting timely access to care.

The CPC initiative launched in October 2012 to advance primary care by paying clinicians to deliver accessible, comprehensive, and coordinated care. Advanced primary care is the foundation of a high-performing health system. In addition to attending to patients’ acute, chronic, and preventive health care needs, primary care practices act as the quarterback of the health care team. CPC practices help patients navigate their care, communicate with specialists and hospitals, and ensure that patients with complex social and medical needs do not “fall through the cracks” of the health care system.

Authorized by the Affordable Care Act, the CPC initiative is a multi-payer partnership between Medicare, Medicaid, commercial payers, and primary care practices in seven regions (Arkansas, Colorado, New Jersey, Oregon, Capital District and Hudson Valley in New York, Cincinnati-Dayton region in Ohio and Kentucky, and Greater Tulsa in Oklahoma). Participating practices identify patients who are sick or at risk and provide targeted care management to improve outcomes and prevent potential adverse events. Patients at CPC practices have 24/7 access to a provider, and receive enhanced self-management and decision-making support. The CPC initiative supports these efforts by paying an additional fee for non-face-to-face care, such as tracking hospital discharges to provide follow-up support to patients.

We are encouraged by the results so far and look forward to seeing the results of our independent evaluation of these practices. Our prior experience with primary care demonstrations shows that it takes time for primary care practices to build infrastructure and improve care delivery. These CPC initiative improvements came earlier than expected in a model involving significant changes in the delivery of primary care. We look forward to supporting these innovative practices in their progress as the initiative continues.

This article was originally published on the CMS Blog