Comprehensive Primary Care Initiative Unveiled at CMS

The Center for Medicaid and Medicare Innovation released the following initiative which appears promising as a way to further payment reform. CMS, through its Center for Medicare and Medicaid Innovation, has announced its next opportunity for partnership between private payers, Medicaid, and Medicare.  Known as the Comprehensive Primary Care Initiative, this solicitation has some exciting potential to support the good work that the Partnership for Healthcare Payment Reform is engaged in. Here are a few highlights: WHAT:  CMS will make enhanced payments to primary care practices in the context of a collaborative, multi-payer environment within five to seven defined geographical markets.  CMS is seeking applications for participation from private and other governmental payers who commit to providing (or who are already providing) enhanced support, above and beyond visit-based fee for service payments, for primary care practices in their networks.  These multi-payer compensation strategies must be designed to support 5 comprehensive primary care functions: Risk-stratified care management
  • Access and continuity of care
  • Planned care for chronic conditions and preventive care
  • Patient and caregiver engagement
  • Coordination of care across the "medical neighborhood"
In addition, CMS seeks to use this initiative to drive enhanced, accountable payment, including accountability for the total cost of care, continuous improvement driven by data; and optimal use of health information technology. CMS is looking to establish this initiative in 5 to 7 markets nationwide. WHO:  Payers are invited to respond individually to the solicitation with a non-binding letter of intent.  Payers eligible to respond include:  commercial insurers, Medicare Advantage plans, states (Medicaid, state employees/retirees), Medicaid managed care plans, state high risk pools, self-insured businesses and administrators, self-insured groups.   In addition, CMS expects that this initiative will stimulate market-wide conversation among payers, providers and community quality collaboratives, and it encourages those conversations to take place before a response to the solicitation is made.   Once markets and payers are selected by CMS, primary care practices will be invited to apply to participate.  Preliminary practice eligibility criteria include:
  •  having at least 60% of revenues generated by payers participating in the initiative
  • having a minimum of 200 non-institutionalized Medicare beneficiaries who are eligible for Part A and enrolled in Part B, but not enrolled in Medicare managed care
  • using an electronic health record system or electronic registry
HOW:  Although payers are asked to respond individually to the solicitation, proposals that demonstrate alignment around payment methodologies ("methods of support that are not segmented by payer") will be favored.  In addition, payers are expected to propose compensation arrangements that include the possibility of shared savings, and to align around methods of sharing data and measuring quality. BY WHEN:  Individual payers must respond with a non-binding letter of intent by November 15, 2011.  

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