Oregon Comprehensive Primary Care Initiative
Program Location:
Portland, OR
Number of Practices:
70
Payer Type:
Multi-Payer
Parent Program:
Payers:
Medicare
CareOregon
Oregon Health Authority (Medicaid FFS)
Providence Health Plans
Regence BlueCross BlueShield
Teamsters Multi-Employer Taft Hartley Funds
Tuality Health Alliance
Reported Outcomes
Description:
Oregon is one of seven markets selected to participate in this four year, multi-payer federal initiative to strengthen primary care capacity by testing a model of comprehensive, accountable primary care supported by multiple payers. Nearly 70 Oregon primary care practices were selected to participate and each is required to be recognized as a Patient-Centered Primary Care Home and to achieve certain CMS milestones over the four years. Enhanced payments to the selected practices began in November 2012 from CMS and five Oregon payers including Regence Blue Cross, Provider Health Plan, CareOregon, Tuality and the OHA (Medicaid FFS).
Related News & Resources
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 component.
Fewer ED / Hospital Visits:
Mathematica Policy Research (January 2015) Independent evaluation of first program year prepared for CMS
- Outpatient ED visits per 1,000 patients declined by 29 (6 percent) for all patients.
Improved Health:
Mathematica Policy Research (January 2015) Independent evaluation of first program year prepared for CMS
Specifically, among patients with diabetes, for CPC beneficiaries relative to comparison beneficiaries in Oregon, the likelihood of:
- HbA1c testing increased by 3 percentage points (4%) for both all patients and high-risk patients, although it was only statistically significant for all patients.
- An eye exam increased by 8 percentage points (14%) for high-risk patients.
- All four tests for diabetes being performed increased by 4 percentage points (11%) for all patients and by 7 percentage points (20%) for high-risk patients.
Cost Savings:
Mathematica Policy Research (January 2015) Independent evaluation of first program year prepared for CMS
- Medicare expenditures and hospitalizations fell over time in Oregon for CPC practices relative to comparison practices; however, the declines were not statistically significant.
- DME increased by $5 (10%) among high-risk patients only (this was the only statistically significant effect on expenditures)
Data Source(s):
Last updated January 2016
