Payment Matters: CMS Announces Comprehensive Primary Care Initiative

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On August 22, CMS announced its selection of 500 primary care practices for inclusion in the Comprehensive Primary Care (CPC) initiative. The CPC initiative involves multiple payment sources, including commercial health plans, and is designed to increase the financial resources available to primary care doctors in order to allow for better coordination of patients' care. The participants in the CPC initiative include primary care practices serving the following regions (links to lists of the participating practices in each region): Arkansas, Colorado, New Jersey, Oregon, New York (Capital District-Hudson Valley Region), Ohio & Kentucky (Cincinnati-Dayton Region) and Oklahoma (Greater Tulsa Region).

The CPC initiative establishes a service delivery model that includes a uniform set of functions to be supported by the participating payers: (1) manage care for patients with high health care needs; (2) ensure access to care; (3) deliver preventative care; (4) engage patients and caregivers; and (5) coordinate care across the "medical neighborhood" (i.e., among the various primary and nonprimary care providers serving the patient). Physicians will initially receive a monthly per beneficiary payment for participating in the CPC initiative, and will eventually have the opportunity to share in the total Medicare savings for their markets.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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