Fwd: FW: Comprehensive Primary Care Initiative

[Guest guest]

received this - interesting...not going to attempt to participate since my current model with my NCBF is working fine but seems like a positive step

what concerns me is that typical hamster wheel practices will take the extra money but never really provide the increased level of care

From: Email - denverms

Sent: Tuesday, May 01, 2012 1:42 PMTo: Email - infoSubject: Comprehensive Primary Care Initiative 

Primary care physicians take note – Colorado has been selected as one of 7 regions to test a new CMS Comprehensive Primary Care Initiative.  CMS’ announcement follows:

  

          A new initiative of the Center for Medicare and Medicaid Innovation (CMM) aims to ensure success of physician efforts to innovate and improve care delivery by cultivating support among private payers.

          The CMM’s new Comprehensive Primary Care Initiative (CPC) is designed to foster collaboration at the local level among private health care payers and primary care physicians so that physicians can lead innovative and sustainable new payment and delivery efforts.

          In this new initiative, Medicare will work with commercial health plans, Medicaid and other state health plans to offer monthly bonus payments to primary care physicians who better coordinate care for their patients.  Colorado (state-wide) has been selected as one of seven geographic markets where the CPC will be tested.

 Care and payment models

          The CMMI has created two models as part of the CPC initiative:  one focusing on care and one on payment.  Under the care model, the CPC will fund primary care practices so they are able to:

 Manage care for patients with high health needs.  Participating primary care practices will be able to focus on multiple or serious health conditions.

Ensure access to care.  Participants will be accessible to patients 24/7.Deliver preventive care.  Participants will proactively assess patients to determine their health care needs and ensure appropriate, timely preventive care.

Engage patients and caregivers.  Participants will be able to encourage patients and their families to actively participate in their care.

Coordinate care across the medical community.  Participants will work with specialists and medical facilities to coordinate care, including through “meaningful use” of electronic health records.

 Under the CPC payment model, CMS will pay a monthly care management fee to select primary care practices for their fee-for service Medicare beneficiaries.  During the first two years of the program, the per-beneficiary fee will average $20 a month.  During the second two years of the program, the fee will average $15 per beneficiary a month.

In addition, participating physicians will have the opportunity to share in any Medicare savings attributed to the CPC.  Participating physician practices also will receive a monthly care management fee from participating private payers.  This collaboration across multiple payers should enable physicians to strengthen their capacity to implement practice-wide quality improvements.

 How to participate

          Once participating private payers in these markets enter into memorandums of understanding with CMS, the CMMI will release a solicitation to primary care practices in the seven geographic markets.  Approximately 75 primary care practices in each designated market will be selected to participate.

          The physician solicitations and application details are expected to be issued sometime early this summer.  In the meantime, interested physicians should review the initiative’s fact sheet to better understand the criteria for this new payment and delivery model.

 

[Guest guest]

Good luck to the Colorado FPs. I am all for the enhanced reimbursement for coordination of care for high risk and costly patients. But............

Doesn't $20 or $15 per month seem paltry for the extra work these patients require to properly manage their care? Especially when one considers the enormous savings that could accrue to the system from good care coordination?

If one had 300 patients at $20 per month that comes to 72K per year which is the minimum it would cost to hire a good RN (with benefits) to do the case management. I am not sure one RN would be enough to do the work required for 300 hi risk / hi utilizing patients.

Maybe if the shared savings actually come back to the physician's office it could be worthwhile, but that is a big leap of faith. As stated, the devil is in the details.

Mike Safran