The Chronic Care Initiative, a multi-payer, collaborative initiative involving public and commercial payers designed to train primary care practices in the PCMH model, has provided support to 171 practices treating over one million patients. Practices have been supported in their transformation through:
Working in concert with private sector partners, state government forwarded the PCMH concept in Pennsylvania through Pennsylvania’s Chronic Care Initiative beginning in 2009, including core components of primary and patient-centered care, innovations in practice redesign and health information technology, and changes to the way practices and providers were paid.
As cited in the State Health Care Innovation Plan, the Chronic Care Initiative was fully implemented across the four regions by October 2009 and included 171 practices and 783 providers serving over 1.18 million patients. The Chronic Care Initiative continues today, having demonstrated improved practice performance and still working with participating practices to achieve practice-wide transformation that produces further improved quality and patient experience, and reduced cost escalation. In 2012, Pennsylvania used the Multi-payer Advanced Primary Care Practice demonstration as a source of supplemental funding for the existing Chronic Care Initiative (CCI), which brought Medicare into the multi-stakeholder, public-private initative.
Under Phase II, practices receive per member per month (PMPM) payments from participating payers. The amounts of these PMPM payments will vary by initiative year and patient age. Phase II of the CCI began in January 2012. Approximately 54 practices from two of the previous CCI rollout regions (Southeast and Northeast) will be participating in Phase II. In conjunction with a change in administration, oversight of the program has moved to the Pennsylvania Department of Health. Pennsylvania was one of the eight states selected to participate in the Medicare Advanced Primary Care Practice (MAPCP) demonstration program. Medicare joined as a participating payer in Phase II of the CCI. Participation in MAPCP ended in December 2014. Also, the federal government provides federal financial participation (FFP) for the enhanced reimbursements that Medicaid managed care organizations and Medicaid fee-for-service pay to participating practices.
Practices will be eligible for shared savings payments that will take into consideration practice performance on key quality and cost metrics. As the PMPM amounts decrease from year 1 to year 3, practices will be eligible for greater shares of any savings.
JAMA Internal Medicine (June 2015)
* (per 1000 patients per month vs. comparison)
American Journal of Managed Care (February 2015)
JAMA Internal Medicine (June 2015)
JAMA (February 2014)
Pennsylvania Academy of Family Physicians (2012)
Joint Commission Journal on Quality and Patient Safety (June 2011)
JAMA Internal Medicine (June 2015)
American Journal of Managed Care (February 2015)
JAMA Internal Medicine (June 2015)
Joint Commission Journal on Quality and Patient Safety (June 2011)
American Journal of Managed Care (February 2015)
The increased utilization of outpatient care is actually suggestive of further success for the PCMH model. By improving coordination of care, doctors may have been appropriately directing their patients to lower-cost, lower-intensity services, which acted as substitutes for costlier hospital admissions and other service.
Physicians in the Pennsylvania managed care practices may be under-referring patients to specialist services, but these differences in specialty care may simply reflect regional variation in practice.
JAMA (February 2014)
A 2014 study published in the Journal of the American Medical Association found that this program "was associated with limited improvements in quality and was not associated with reductions in utilization of hospital, emergency department, or ambulatory care services or total costs of care over 3 years."