Ohio & Kentucky Comprehensive Primary Care Initiative
Program Location:
Cincinnati, OH
Number of Practices:
75
Payer Type:
Multi-Payer
Partner Organizations:
The Health Collaborative
Ohio's Patient-Centered Primary Care Collaborative
Ohio Academy of Family Physicians
Ohio Department of Health
Parent Program:
Payers:
Aetna
Amerigroup
Anthem Blue Cross Blue Shield of Ohio
Humana
HealthSpan
Medical Mutual
UnitedHealthcare
Medicare
Centene Corporation
Ohio Medicaid
Reported Outcomes
Description:
Ohio’s Cincinnati-Dayton region is one of the seven markets selected to participate in the CPC initiative. The Ohio-Kentucky designated area contains 75 primary care practices, 61 of which are located in Ohio, with 261 providers and an estimated 44,500 Medicare beneficiaries. The region is composed of the following 14 counties: Adams, Butler, Brown, Champaign, Clark, Clermont, Clinton, Greene, Hamilton, Highland, Miami, Montgomery, Preble and Warren. 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.
The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients.
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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.
Increased Preventive Services:
Mathematica Evaluation (January 2015) Independent evaluation of first program year prepared for CMS
- There were very few statistically significant effects on the quality-of-care measures among either all or high-risk patients in Ohio/Kentucky during the first year of the initiative (Table 8.14). Specifically, relative to the comparison group:
- The percentage of CPC beneficiaries with diabetes who received a urine protein test increased by 5 percentage points (7 percent) for high-risk patients only.
Other Outcomes:
Mathematica Evaluation (January 2015) Independent evaluation of first program year prepared for CMS
Unfavorable impacts on cost:
- During the first year of CPC, there were statistically significant effects on Medicare expenditures both with and without care management fees among all patients and high-risk patients. For the CPC group relative to the comparison group:
- Monthly Medicare expenditures without fees increased by $29 (4 percent) for all patients and by $108 (7 percent) for high-risk patients.
- Net monthly Medicare expenditures with fees increased significantly by $48 (6 percent) for all patients and by $137 (9 percent) for high-risk patients.
- For all patients, the increase in Medicare expenditures was due to statistically significant increases in inpatient expenditures ($21) and physician expenditures ($11), and small but not statistically significant increases in outpatient expenditures, DME, and home health services. There was also a statistically significant $7 decline in expenditures for skilled nursing facility services.
- For high-risk patients, the increase in Medicare expenditures was due to statistically significant increases in inpatient expenditures ($61), physician expenditures ($34), outpatient expenditures ($19), and DME ($8).
Unfavorable effects on utilization:
- Among all patients in Ohio/Kentucky, there were no statistically significant impacts on Medicare service use outcomes. Among high-risk patients, there was one statistically significant finding for the CPC group relative to the comparison group:
- Annual observation stays per 1,000 beneficiaries increased by 16 (18 percent)
- ACSC admissions increased by 6 and 23 per 1,000 patients, or by 8 and 13 percent, respectively, among all and high-risk CPC patients.
Data Source(s):
Last updated February 2019
