Update: Christopher F. Koller on a Big Week For Primary Care Transformation

This has been a big week for supporters of multi-payer alignment in health care and primary care transformation. On Monday, April 11, the Centers for Medicare and Medicaid Innovation (CMMI) announcedthat they will be implementing a new payment model—Comprehensive Primary Care Plus (CPC+). On Thursday, they released much delayed results from the evaluation of the second-year performance of the Comprehensive Primary Care (CPC) initiative payment model, the precursor to CPC+.

CPC+ represents a significant expansion to CMMI’s commitment to multi-payer primary care transformation. Compared to the original CPC payment model (seven markets, 500 practices, four years), it is bigger (20 markets and 2,000 practices) and longer (five years). It sets forth two different payment models for Medicare patients based on disease severity and progressively higher standards for primary care practices to meet to be considered “transformed.”

It also represents the country’s biggest commitment in health care to multi-payer financial alignment. As in CPC, it invites commercial payers and Medicaid in a geographic market to come together and commit to Medicare’s primary care standards and payment mechanisms. Once markets are selected, practices will be invited to apply. All this is to be accomplished by January 1, 2017, when the payment model is scheduled to begin. With abundant evidence supporting the relationship between the importance of a high-performing primary delivery system and improved population health, the Fund has, through its Multi-State Collaborative, supported markets in CPC as well as its predecessor program, the Medicare Advanced Primary Care Practice. We have also convened payers in the CPC program to help understand what it means when payers, who have historically competed with one another, align their efforts for work they cannot accomplish on their own.

So how is this payment model, with its two key components—primary care transformation and multi-payer alignment—doing? On Thursday, April 14, CMMI released the much-delayed evaluation of the second-year performance of the CPC project. The results are encouraging but not overwhelming. Performance across regions versus comparison groups was statistically superior in a few quality measures. CPC practices on the whole are saving the Centers for Medicare & Medicaid Services money, but not yet enough to recoup the increased fees they are being paid.

However, the story is more nuanced within the seven CPC markets. Several are seeing savings and quality improvements. This is no surprise—local environments and implementation both matter. Within the practices themselves, researchers found the strongest improvements in care management for high-risk patients and in access to care. Individual payers, with more recent data, report improved performance in multi-payer primary care transformation projects in later years. In payment reform projects, such as CPC, the emphasis needs to be on learning and improvement over time. Expectations of an early and authoritative verdict are unreasonable.

The Fund will continue to support the work of multi-payer primary care transformation projects through its Multi-State Collaborative. In addition to convening the regional projects, the Collaborative will focus on project governance and management, feedback reporting, and performance improvement. Medicare’s ongoing leadership in this work is a much needed catalyst.