CMS: Population Health Management Reduces Admissions, ER Use

Two population health management initiatives that focus on increasing the use of primary care providers have reaped significant results for patients, says CMS Deputy Administrator and Chief Medical Officer Dr. Patrick Conway.  The Comprehensive Primary Care (CPC) and Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration have reduced hospital admissions by 2 percent, cut emergency department use by 3 percent, and saved approximately $4.2 million, according to a report and blog post detailing the results.

The CPC initiative, launched in 2012, asked public and private payers in seven regions to utilize data-driven population health management techniques to plan and provide primary care services based on risk stratification, patient engagement, and improved coordination of care.  Nearly five hundred practices participated during the program’s first year, covering 345,000 Medicare patients and more than 2 million private insurance beneficiaries. [CMS-logo]

Reduced hospital admissions and emergency department visits by the highest risk patients provided the majority of the $227,000 in care management fees paid to the average practice.  The program generated a total of $141.3 million in payments from CMS and private payers.  Participating providers also received data feedback from payers detailing their care quality as well as CMS education and support to encourage the necessary organizational transformation.  The process revealed that healthcare organizations with robust EHR and health information exchange capabilities, as well as those previously participating in the EHR Incentive Programs, were more likely to successfully adapt to the requirements of the CPC initiative.

Meanwhile, the state-administered MAPCP Demonstration created a collaboration between Medicare, Medicaid, and private payers in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island, and Vermont.  “Under this demonstration, participating practices and other auxiliary supports (e.g., community health teams) receive monthly care management fees from the participating payers and additional support (e.g., data feedback, learning collaboratives, practice coaching),” Conway explains.