PCPCC Applauds Federal Government’s New & Largest-Ever Multipayer Initiative to Improve Primary Care

FOR IMMEDIATE RELEASE
April 11, 2016

Statement Attributable to:
Marci Nielsen, PhD, MPH
President & CEO
Patient-Centered Primary Care Collaborative

PCPCC Applauds Federal Government’s New & Largest-Ever Multipayer Initiative to Improve Primary Care

Designed to improve quality and cost, Comprehensive Primary Care Plus expands multi-payer investment in primary care medical homes

“The Patient-Centered Primary Care Collaborative (PCPCC) commends the Centers for Medicare & Medicaid Services (CMS) for creating the Comprehensive Primary Care Plus (CPC+) Initiative, which was announced today. CPC+ is the largest-ever initiative to transform and improve how primary care is delivered and paid for in America. This progressive comprehensive primary care model will be implemented in up to 20 regions and can accommodate up to 5,000 practices, encompassing more than 20,000 doctors and clinicians and the 25 million people they serve.

“The PCPCC has long advocated for this type of multi-payer evolution in health delivery and payment reform. Decades of research has shown that health care systems built on a strong foundation of comprehensive primary care lead to better care, smarter spending, and healthier people. The program announced today combines the power of comprehensive primary care with much needed payment reform.

 “The CPC+ is structured around multi-payer collaboration – one that aligns payment and performance measures across state, federal, and commercial payers in partnership with primary care providers. The research supports that these multi-payer efforts are positioned to scale and spread best practices to optimize primary care delivery for patients and families. The PCPCC’s Annual Patient-Centered Medical Home Evidence Report highlights 30 medical home evaluations that point to a clear trend in reducing health care costs and/or unnecessary utilization, such as emergency department (ED) visits, inpatient hospitalizations and hospital readmissions. Those with the most impressive cost and utilization outcomes were generally those that participated in multi-payer collaboratives.

“As described in the Annual Evidence Report, practices face several challenges when assuming the financial risk and accountability in a patient-centered medical home model of care. These challenges include: the need for adequate and predictable payment together with appropriate risk adjustment – especially when caring for high-cost, high-need patients; team-based care that integrates behavioral health and coordinates care across the medical neighborhood and community; interoperable electronic health records and population health management tools; other technology to support patients and practices – such as telehealth and mobile health applications; access to timely integrated data at the point of care, and authentic patient and family engagement in care transformation. CPC+ incorporates this learning with up-front investment to practices, payment based on the health needs/risk of their patients, a push for health information technology that benefits care delivery, and a focus on patient and family engagement.

“Given the variability in primary care practice readiness for delivery and payment reform, CPC+ is designed to meet primary care practices wherever they may be along the practice transformation continuum. CPC+ will allow practices to apply for one of two program tracks that is matched to their level of ‘practice readiness’ with increasing payment and care redesign expectations from Tracks 1 to 2. Track 1 is very similar to the existing Comprehensive Primary Care (CPC) initiative and targets practices that have the requisite infrastructure to deliver comprehensive primary care services. Track 2 is designed for more advanced practices that are already proficient in delivering these services but stand ready to offer additional supports for complex patients.

“The CPC+ initiative represents the future of health care. It encourages the type of comprehensive primary care that not only leads to more effective, efficient, and patient-centered care but also embraces value. It moves us a significant step forward in providing the necessary payment structures to enable primary care providers to operate as high functioning patient-centered medical homes – with clinicians and care teams that offer trusted healing relationships with patients and their families.”

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Editor's Note: To arrange an interview with Marci Nielsen, contact Amanda Holt, 202-640-1212, or amanda@pcpcc.org. We also invite you to access our online Primary Care Innovations and PCMH Map where we track these types of advanced primary care programs nationwide. You can view the CPC+ initiative listed on our map here.

About the PCPCC

Founded in 2006, the PCPCC is a not-for-profit membership organization dedicated to advancing an effective and efficient health care system built on a strong foundation of primary care and the patient-centered medical home (PCMH). The PCPCC achieves its mission through the work of its volunteer members, Stakeholder Centers, experts, and thought leaders focused on key issues of delivery reform, payment reform, patient engagement, and benefit design to drive health system transformation. For more information, or to become an executive member, visit www.pcpcc.org.