New Jersey Comprehensive Primary Care Initiative
Program Location:
Trenton, NJ
Number of Practices:
70
Payer Type:
Multi-Payer
Partner Organizations:
New Jersey Health Information Technology Extension Center (NJ-HITEC)
Parent Program:
Payers:
Amerigroup
AmeriHealth New Jersey
Horizon Blue Cross Blue Shield of New Jersey
Teamsters Multi-Employer Taft Hartley Funds
United Healthcare
Medicare
Reported Outcomes
Description:
New Jersey was selected to participate in a federal pilot that aims to transform primary care practices into patient-centered medical homes that cut costs and enhance care by eliminating duplicative and unnecessary treatments. The Comprehensive Primary Care (CPC) initiative will seek to strengthen free- standing primary care capacity by testing a model of comprehensive, accountable primary care supported by multiple payers. 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.
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Payment Model:
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative.
In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level. The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings componen
Fewer ED / Hospital Visits:
Mathematica Policy Research (January 2015) Independent evaluation of first program year prepared for CMS
Among all patients in New Jersey, there were several favorable impacts on Medicare service use outcomes:
- Hospitalizations per 1,000 patients per year declined by 15 (5 percent).
- Annual specialist visits in all settings declined by 1,142 per 1,000 patients (6 percent).
- Annual primary care clinician visits in all settings declined by 574 per 1,000 patients (7 percent)
Cost Savings:
Mathematica Policy Research (January 2015) Independent evaluation of first program year prepared for CMS
During the first year, statistically significant findings for the CPC group relative to the comparison group include:
- Average monthly Medicare expenditures (without care management fees) declined relative to the comparison group by $45 (5 percent) among all patients in New Jersey. The CPC-comparison difference suggests savings of $26, but was not quite statistically significant (p = 0.103) for Medicare expenditures with care management fees.
- Sizable differences in Medicare expenditures (of about 5 percent) between CPC and the comparison group began in Quarter 1, and became statistically significant in Medicare expenditures in Quarter 3 and continued to Quarter 4
- About half the decline in Medicare expenditures without fees was due to a reduction in inpatient expenditures ($22), nearly a fifth was due to a reduction in physician expenditures ($8), another fifth due to a reduction in outpatient expenditures ($8), and about 5 percent was due to a reduction in expenditures on home health services ($2). (A reduction in expenditures for skilled nursing facility use also contributed to the decline, but was not statistically significant.)
Other Outcomes:
Mathematica Policy Research (January 2015) Independent evaluation of first program year prepared for CMS
There was a statistically significant unfavorable effect for one of the quality-of-care process measures for diabetes:
- HbA1c testing declined by 3 percentage points (3 percent) among all patients in New Jersey.
Data Source(s):
Last updated January 2016
