CMS published results from the first evaluation of Comprehensive Primary Care Initiative and Multi-Payer Advanced Primary Care Practice Demonstration.

1. How is the Transformation of
Primary Care Going?
Results from the First Evaluation Report
Comprehensive
Primary Care
Initiative
Source:
http://innovation.cms.gov/Files/r
eports/CPCI-EvalRpt1.pdf
Multi-Payer Advanced
Primary Care Practice
Demonstration
Source:
http://innovation.cms.gov/Files/r
eports/MAPCP-EvalRpt1.pdfAccess &
continuity
5
Functions
Planned
care for
chronic
conditions
&
preventive
care
Risk -stratified
care
management
Patient &
caregiver
engagement
Coordination of care
across the medical
neighborhood
Participants
Payers Practices Clinicians
29 492 2,158
Patients 2.5 Million
Regions 7:
Arkansas Colorado
New Jersey Oregon
New York: Capitol District Hudson Valley
Ohio/Kentucky: Cincinnati-Dayton Region
Oklahoma: Greater Tulsa Region
Practice Care
Management Fees Paid
$141.3 million
For care of 1.2 million patients
including 315,000 Medicare
beneficiaries
Evaluating Milestone
Progress
38 practices received notice of corrective
action needed and 4 were terminated.
Published by
Medical Business Systems
and Iridium Suite
Practice Management
Software
www.iridiumsuite.com
$14 (2%) less in Medicare A & B
expenditures per beneficiary per
monthly.
(Monthly care management
Fees average $20.)
2% reduction in hospitalizations
and 3% reduction in emergency
department visits.
Participants
8 states:
Maine Michigan Minnesota New York
North Carolina Pennsylvania
Rhode Island Vermont
Measuring Performance
252 total round 1 site visits
Maine $6.95
Michigan $2.00 + $4.50 (if have a
care manager) + P4P incentives
Minnesota $10.14 (1–3 conditions) /
$20.27 (4–6 conditions) / $30.00 (7–9
conditions) / $45.00 (10+ conditions)
+ 15% for mental illness
+ 15% for patients who speak
English as a second language
NewYork $7.00
North Carolina $2.50 / $3.00 / $3.50
(NCQA Level 1 / 2 / 3)
Pennsylvania $1.08 + $0.43 (age
1–18) / $1.08 (age 19–64) / $3.61 age
65–74) / $5.06 (age 75+)
+ Up to 50% of the net savings they
generate for a payer, based on cost
and quality performance
Rhode Island $5.00 (0–1
performance targets met) / $5.50
(utilization target and 1 other target
met) / $6.00 (all targets met)
Vermont $1.20 to $2.39 (depending
on NCQA 2008 score)
Practice Care
Management Fees Paid
Monthly Medicare payments
per member to practices
Gross savings $ 40,314,752
Minus MAPCP Fees $ 33,215,984
Equals net savings $ 4,190,227
Best: Michigan $ 27,751,046
Worst: North Carolina ($ 11,375,882)
Medicare ROI:$1.35 in savings for every
$1 Medicare paid out