Evaluation of the Comprehensive Primary Care Initiative: Second Annual Report

Executive Summary

In October 2012, the Center for Medicare & Medicaid Innovation (CMMI) of the Centers for Medicare & Medicaid Services (CMS) launched the Comprehensive Primary Care (CPC) initiative. This unique collaboration between CMS and other private and public payers— including commercial insurers and Medicaid managed care plans—aims to improve primary care delivery and achieve better care, smarter spending, and healthier people. CPC also aims to enhance provider experience.

CPC tests a new approach to care delivery for nearly 500 primary care practices across seven regions. The initiative focuses on helping practices implement five key functions in their delivery of care: (1) access and continuity, (2) planned care for chronic conditions and preventive care, (3) risk-stratified care management, (4) patient and caregiver engagement, and (5) coordination of care across the medical neighborhood (Figure ES.1). These functions are considered a primary driver in achieving the CPC aims, as specified in the CPC change package. 1 CMS specified a series of Milestones to help move practices along the path of implementing these functions, and it updates the requirements for each Milestone annually to build on practices’ progress in the prior year. CMS assesses whether practices meet targets set within the Milestones, which are considered minimum requirements to remain in the program. While the CPC Milestones overlap with many of the activities typically included in existing patient-centered medical home (PCMH) recognition programs, CPC did not require practices to have or obtain PCMH recognition. To help participating practices meet the Milestone requirements and make the changes in care delivery outlined in the CPC change package, CMS offers support, including enhanced payment, data feedback, and learning activities. 

Overview of Findings

CPC’s second program year saw stable participation among payers and practices, as well as notable progress in the initiative’s implementation. CPC’s financial support for participating practices in PY2014 remained substantial and comparable to PY2013 levels, with the median practice receiving enhanced CPC payments (from all participating payers combined) equivalent to 14 percent of 2014 total practice revenue, or $203,949. Continued refinement of data feedback and the learning supports provided to practices occurred over the period, and, in general, practices were pleased with the changes.

Practices spent much of CPC’s first program year (PY) (PY2013, defined as fall 2012 through December 2013) trying to understand CPC and set up staffing, care processes, and workflows. In PY2014 (January through December 2014), practices made substantial headway in CPC Milestone activities and changing care delivery. Qualitative data from a small number of participating practices point to a stronger understanding of the goals of CPC in 2014, more robust staffing and systematic care processes for implementing the changes identified in the CPC change package, and the adoption of various enhanced approaches to delivering care compared to CPC’s first program year. Indeed, data collected from all CPC practices demonstrate progress in the Milestone activities and the CPC change package more generally, with improvement in their self-reported approaches to delivering various aspects of primary care. The biggest improvements were in the delivery of risk-stratified care management and expanded access to care.