Colorado Comprehensive Primary Care Initiative
Program Location:
Denver, CO
Number of Practices:
71
Payer Type:
Multi-Payer
Partner Organizations:
HealthTeamWorks
Parent Program:
Payers:
Medicare
Anthem Blue Cross Blue Shield of Colorado
Cigna
Colorado Access
Colorado Choice Health Plans
Colorado Medicaid
Humana
Rocky Mountain Health Plans
Teamsters Multi-Employer Taft Hartley Funds
UnitedHealthcare
Aetna
Reported Outcomes
Description:
The CPCi is a nationwide, multipayer project from the CMS Innovation Center providing enhanced compensation for high-quality, coordinated, patient-centered care to Medicare patients. 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. CPCi participants in Colorado will essentially adopt the healthcare model proven by the Colorado Patient-Centered Medical Home (PCMH) Multi-Payer Pilot, which involved 16 primary care practices and seven health plans from 2009-2012.
Aetna joined the CPC as a participating payer in October of 2013.
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Payment Model:
Under the Comprehensive Primary Care Initiative, CMS will pay primary care providers for improved and comprehensive care management, and after two years offer them the chance to share in any savings they generate. CMS will look to collaborate with other payers in local markets who will commit to similar changes to how they engage primary care practices.
- Monthly Care Management Fees for Medicare Fee-for-Service Beneficiaries: CMS will pay participating practices a risk adjusted, monthly care management fee for their Medicare Fee-for-Service beneficiaries. For the first two years of the initiative, the per-beneficiary, per-month (PBPM) amount will average out to $20; for years 3 and 4, the PBPM will be reduced to an average of $15.
- Shared Savings in Medicare Fee-for-Service: After two years, all practices participating in this initiative will have the opportunity to share in a portion of the total Medicare savings in their market.
Improved Access:
Mathematica Evaluation (January 2015) Independent evaluation of first program year prepared for CMS
- There was only one statistically significant finding for quality-of-care outcomes (Table 8.8). Among all patients, relative to the comparison group, the CPC group:
- Improved one measure of continuity of care, because there was a significant increase in the percentage of all office visits with the patients’ attributed practice of 2 percentage points (4 percent)
Other Outcomes:
Mathematica Evaluation (January 2015) Independent evaluation of first program year prepared for CMS
- During the first year, there were no statistically significant effects on Medicare expenditures with or without care management fees among all or high-risk patients in Colorado
- Among all patients in Colorado, there were no statistically significant effects for the CPC group relative to the comparison group
Data Source(s):
Last updated May 2018
