CMS:Comprehensive Primary Care Initiative

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Now is the time to change the payment paradigm from acute care to chronic/patient centered care. SV

The Comprehensive Primary Care (CPC) initiative is a new CMS-led, multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care for all Americans. 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. 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 5-7 selected localities across the country.

The CPC initiative will test two models simultaneously: a service delivery model and a payment 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.

The Innovation Center is now accepting letters of intent from public and private health care payers for the Comprehensive Primary Care initiative.

The first step is for public and private payers (including states) to indicate their interest to CMS, including the level and type of support for primary care practices being offered. Interested payers must submit a nonbinding letter of intent and a completed Geographic Service Area Worksheet by November 15, 2011 via email to CPCi@cms.hhs.gov. Applications from payers that do not submit a timely letter of intent will not be considered.

Final applications, to be completed only after the letter of intent has been submitted, must be received on or before January 17, 2012. Once CMS evaluates these proposals and selects the markets, a second solicitation will be issued for primary care practices in those markets.