Advanced Primary Care Initiatives Reduce Hospital Admissions, ED Visits: CMS

Preliminary findings from two advanced primary care initiatives from CMS show decreased hospital admissions and emergency department (ED) visits, CMS officials report.

The two large-scale tests of advanced primary care—the Comprehensive Primary Care (CPC) initiative and the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration— showed a 2 percent decrease in hospital admissions and a 3 percent decrease in ED visits, contributing to the reduction of expenditures nearly enough to offset care management fees paid by CMS. The MAPCP Demonstration generated an estimated $4.2 million in savings through the use of advanced primary care initiatives.

Highlights of the two initiatives are as follows:

  • Comprehensive Primary Care initiative: A unique multi-payor partnership between Medicare, Medicaid private healthcare payors and primary care practices in four states (Arkansas, Colorado, New Jersey and Oregon) and three regions (New York’s Capital District and Hudson Valley, Ohio and Kentucky’s Cincinnati-Dayton region, and Oklahoma’s Greater Tulsa region)
    • This initiative provides care management for those at greatest risk; improves healthcare access; tracks patient experience; coordinates care with hospitals and specialists; and uses health information technology (HIT) to support population health.
    • Practices receive non-visit based care management fees from the participating payors, and the opportunity to share in savings.
    • In the first year, 492 practices participated, serving about 345,000 Medicare beneficiaries and more than 2.5 million patients overall. Results from this first year suggest that CPC has generated nearly enough savings in Medicare healthcare expenditures to offset care management fees paid by CMS.

  • Multi-payer Advanced Primary Care Practice Demonstration: A multi-payor initiative in which Medicare participates with Medicaid and private healthcare payors in eight advanced primary care initiatives in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island, and Vermont.
    • Unlike CPC, the states convene the participants and administer the initiatives rather than CMS. Under this demonstration, participating practices and other auxiliary supports (e.g., community health teams) receive monthly care management fees from the participating payors and additional support (e.g., data feedback, learning collaboratives, practice coaching).
    • More than 3,800 providers, 700 practices, and 400,000 Medicare beneficiaries participated in the first year. During the first year, the demonstration produced an estimated $4.2 million in savings.

    The MAPCP initiative is contingent on the use of nurse care managers or care coordinators, restructuring of staff, improvements in patient flow, adoption of health information technology, and more frequent staff meetings. Medicare was able to integrate seamlessly with the structure and organization of the eight state initiatives. Medicare’s participation sent a strong signal about the importance of primary care and the potential of these programs, helping to affirm payor and provider commitments.

    Source: CMS, January 23, 2015

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This entry was posted in Accountable Care Organizations, affordable care act, Avoidable Hospitalization, Care Coordination, Case Managers, Healthcare Reform, Healthcare Spending, Physician Organizations, Population Health Management and tagged , , , , . Bookmark the permalink.
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