- Practices that took part in CMS' Comprehensive Primary Care Initiative (CPC) showed improvements in primary care, such as better management of high-risk patients, improved access and enhanced coordination of care transitions, leading to a 2% reduction in emergency department visits compared to practices not in the model, according to a new Health Affairs study.
- But the program did not save money overall. It did not reduce Medicare spending enough to cover the associated management fees or "appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures."
- The study comes as HHS Secretary Alex Azar has pledged to accelerate the country's shift from fee-for-service payments to value-based payment models. The program came from the Center for Medicare and Medicaid Innovation, which CMS has recently said may go in “a new direction.”
As the healthcare industry slowly moves toward reimbursement models focused more on value than volume, data from these new approaches show mixed results. Programs aim to find ways of cutting costs while also improving care and patient experience, but achieving all of these goals is difficult.
Nearly 500 primary care practices participated in CPC between its launch in 2012 and 2016. The program offered care management fees to providers in addition to regular reimbursement and required them to implement core value-based functions like continuity of care and planned care for chronic conditions.
The new study follows an initial paper that had similar findings. Researchers were concerned the initial study, which examined the first two years of the CPC program, may have not allowed enough time for practices to implement changes or for improved outcomes to be evident.
But that does not appear to be the case. The new study, which looked at four years of data, found that there were no significant differences between spending growth or claims-based quality-of-care measures for diabetes patients between the CPC participants and comparison practices.
However, in 2016, CPC practices did exhibit more timely followup after hospital and ED visits, with 60% of CPC practices contacting beneficiaries within three days of a discharge, compared to 50% for comparison practices, and 59% of CPC practices following up within a week of an ED visit, compared to 51% for the comparison group.
Also, doctors in CPC practices highly regarded the program in 2016, as 80% said that it improved quality of care and 79% said that they support their practice partaking in the program. While many said that the reporting burden for the CPC program was difficult, the study found there were no differences in physician burnout compared to the control group.
The authors say the findings "illustrate how hard it is to reduce Medicare spending," pointing to several reasons they believe the program did not show better results:
- Primary care practices may need "stronger value-based financial incentives" that better align with other care providers such as specialists or hospitals who care for the same patients.
- Reporting burden was worsened by limited data feedback and inadequate health IT support.
- Comparison practices' incentive to improve care in response to Medicare penalties for high re-admission rates could have masked CPC improvements.
"As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care," the researchers write.