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.