Evaluation of the Comprehensive Primary Care Initiative: First Annual Report

EXECUTIVE SUMMARY

What are CPC’s impacts on cost, service use, and quality for attributed Medicare FFS beneficiaries?
CPC is intended to reduce Medicare FFS expenditures by reducing patients’ need for highcost services such as hospitalizations and emergency department (ED) visits. It is also intended to improve the quality of care. Based on earlier literature on initiatives that transform primary care practices, we anticipated it may take 18 months to three years for practices to transform and to see effects on cost, service use, and quality, if CPC is effective (Nutting et al. 2011; McNellis et al. 2013; Solberg et al. 2013; Sugarman et al. 2014). 

As noted above, results from all seven regions combined—measured over the first 12 months of CPC—suggest that the initiative has generated enough savings in Medicare Part A and B health care expenditures to nearly cover the CPC care management fees paid by CMS for attributed Medicare FFS beneficiaries (Table ES.2). However, because of the possible unobserved CPCcomparison differences at baseline, the concentration of favorable findings in several regions and their early timing, as well as some unexpected adverse results in other regions, we recommend that these findings be interpreted with caution at this time.

During the first year, across all attributed Medicare FFS beneficiaries, CPC appears to have reduced total monthly Medicare Part A and B expenditures per beneficiary (compared to what they would have been absent the CPC intervention) by $14, or 2 percent (not including care management fees paid). The reductions appear to be due to the favorable initiative-wide impacts on hospitalizations and ED visits (total and outpatient). Impacts were nearly large enough to offset CMS’s monthly care management fees, which average $20 per attributed beneficiary at participating practices. The reductions in expenditures for Medicare services render the initiative close to cost neutral for Medicare FFS as a whole, but suggest that CPC has not generated net savings during this first year. The expenditure and service use impact estimates differ significantly across regions, with the favorable initiative-wide results driven mainly by Oklahoma, where CPC generated favorable impacts on the key expenditures and service utilization outcomes (including Medicare expenditures, hospitalizations, and ED visits), and to a lesser extent by New Jersey (for Medicare expenditures), New York (for hospitalizations), and Oregon (for outpatient ED visits).