The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.
The Participating Practices
69 Primary Care Practices 275 Providers 4 Payers
74 Primary Care Practices 369 Providers 9 Payers
New Jersey: Statewide
71 Primary Care Practices 272 Providers 5 Payers
New York: Capital District-Hudson Valley Region
79 Primary Care Practices 287 Providers 6 Payers
Ohio & Kentucky: Cincinnati-Dayton Region
75 Primary Care Practices 276 Providers 10 Payers
Oklahoma: Greater Tulsa Region
68 Primary Care Practices 280 Providers 3 Payers
67 Primary Care Practices 552 Providers 6 Payers
Primary care is critical to promoting health, improving care, and reducing overall system costs, but it has been historically under-funded and under-valued in the United States. Without a significant enough investment across multiple payers, independent health plans-- covering only their own members and offering support only for their segment of the total practice population-- cannot provide enough resources to transform entire primary care practices and make expanded services available to all patients served by those practices.
A primary care practice is a key point of contact for patients’ health care needs. In recent years, new ways have emerged to strengthen primary care by improving care coordination, making it easier for clinicians to work together, and helping clinicians spend more time with their patients. All around the country, health care providers and health plans have taken the lead in investing in primary care. Employers across the country have found that with health coverage policies that emphasize primary care, coordinated care, and other strategies that keep their employees healthy, they not only support a healthier workforce, they create a healthier bottom line.
The Comprehensive Primary Care Initiative will build on these and other efforts.
The CPC initiative offers a way to break through this historical impasse by inviting payers to join with Medicare in investing in primary care in 7 selected localities across the country. Eligible practices in each market were invited to apply to participate and start delivering enhanced health care services in the fall of 2012.
Practices were selected through a competitive application process based on their use of health information technology, ability to demonstrate recognition of advanced primary care delivery by accreditation bodies, service to patients covered by participating payers, participation in practice transformation and improvement activities, and diversity of geography, practice size and ownership structure.
The resources will help doctors work with patients to ensure the following:
- Manage Care for Patients with High Health Care Needs: Patient with serious or multiple medical conditions need more support to ensure they are getting the medical care and/or medications they need. Participating primary care practices will deliver intensive care management for these patients with high needs. By engaging patients, primary care providers can create a plan of care that uniquely fits each patient’s individual circumstances and values.
- Ensure Access to Care: Because health care needs and emergencies are not restricted to office operating hours, primary care practices must be accessible to patients 24/7 and be able to utilize patient data tools to give real-time, personal health care information to patients in need.
- Deliver Preventive Care: Primary care practices will be able to proactively assess their patients to determine their needs and provide appropriate and timely preventive care.
- Engage Patients and Caregivers: Primary care practices will have the ability to engage patients and their families in active participation in their care.
- Coordinate Care Across the Medical Neighborhood: Primary care is the first point of contact for many patients, and takes the lead in coordinating care as the center of patients’ experiences with medical care. Under this initiative, primary care doctors and nurses will work together and with a patient’s other health care providers and the patient to make decisions as a team. Access to and meaningful use of electronic health records should be used to support these efforts.
The CPC initiative will test two models simultaneously: a service delivery model and a payment model.
Service Delivery Model
The service delivery model will test comprehensive primary care, which is characterized as having the following five functions:
- Risk-stratified Care Management;
- Access and Continuity;
- Planned Care for Chronic Conditions and Preventative Care;
- Patient and Caregiver Engagement;
- Coordination of Care Across the Medical Neighborhood.
The payment model includes a monthly care management fee paid to the selected primary care practices on behalf of their fee-for-service Medicare beneficiaries and, in years 2-4 of the initiative, the potential to share in any savings to the Medicare program. Practices will also receive compensation from other payers participating in the initiative, including private insurance companies and other health plans, which will allow them to integrate multi-payer funding streams to strengthen their capacity to implement practice-wide quality improvement.
- Comprehensive Primary Care Initiative Fact Sheet (PDF)
- FAQ: The CPC initiative and participation in other CMS initiatives (PDF)
- Webinar: The CPC Initiative for Primary Care Practitioners
- Application materials (archived): CPC Primary Care Practice Solicitation (PDF) | CPC Payer initiative solicitation (PDF)
For more information, please send your questions to CPCi@cms.hhs.gov.