HHS Introduces Coordinated Care Pilot for PCPs

The Department of Health and Human Services is recruiting private payers to participate in a Medicare shared savings pilot oriented to primary care physicians.

The goal is to align physician practices and health insurers to coordinate care for Medicare patients, including managing the care of high-risk patients; promoting easy access to care, delivering preventive care engaging patients.

The four-year Comprehensive Primary Care Initiative will provide participating PCPs with an enhanced payment to deliver higher quality, more coordinated, and patient-centered care. In the first year of the pilot the payment will average $20 per month, per beneficiary. Shared savings will kick in during years two through four.

Other programs promote the formation of accountable care organizations, the bundled payment initiative and the partnership for patients. There is about $10 billion in the ACA budget to finance these initiatives, but HHS said a specific budget for the new program hasn't been developed.

The pilot is an effort to create a partnership between Medicare and other payers to invest in a new primary care health delivery and payment model. "We've heard the message loud and clear that if we want to change the healthcare delivery system we need to support primary care," said Dr. Richard J. Gilfillan, M.D., acting director of the Innovation Center at the Centers for Medicaid & Medicare Services during the press call to announce the program.

Peter W. Carmel, M.D., president of the American Medical Association, in a press statement, pointed to shortcomings of the existing payment model. "Physicians want to deliver coordinated, cost-effective care that improves patient outcomes, but the current payment system often penalizes the valuable services that make these improvements possible. By providing a monthly care management fee for Medicare patients, CMMI is recognizing the full scope of work done by physician practices to improve the health of their patients. Participation by private health insurers will strengthen the reach and success of the program."

CMS is recruiting a variety of private insurers and third-party administrators as well as Medicaid managed care plans to participate in the initiative. The agency hopes to convince enough insurers to serve five to seven communities and about 350,000 Medicare beneficiaries.

The location of the communities will depend on the payers selected. Once the payers and markets have been selected, primary care practices will be recruited for each community. CMS hopes to recruit 75 practices per market for the pilot.

CMS has set an aggressive timeline for pilot implementation. Insurers must file a nonbinding letter of intent by Nov. 15 and a final application by mid-January 2012. Insurers will be selected during the first quarter. Primary care physicians will apply and be selected during spring 2012 and the program will be implemented by that summer.

The program is modeled after successful programs developed by Michelin North America Inc. and WellPoint. Dick Wilkerson, chairman and president of Michelin spoke at the press conference announcing the HHS initiative.

He noted that a program Michelin implemented to coordinate the care for the company's diabetic employees had reduced the cost of that care by $300 per employee.

The American College of Physicians was quick to lend its support to the comprehensive primary care initiative. "The initiative offers enormous potential to promote the kind of personalized and coordinated care that patients seek and that physicians want to deliver," said Steven Weinberger, M.D. and CEO of the ACP in a press statement. "We are particularly pleased that this initiative invites other payers to join with Medicare to support comprehensive, coordinated, and patient-centered primary care. Aligning support from multiple payers will provide a more realistic evaluation of these innovative payment and delivery reforms."

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