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Public-private care coordination program provides bonuses


You may live in an area that is part of a public-private payer program through which you could earn bonus payments for care coordination.

The Comprehensive Primary Care initiative (CPCI), a program by the Centers for Medicare and Medicaid Services (CMS), works with commercial and state health insurance plans. CMS announced April 11 the seven markets where it will launch the program: The states of Arkansas, Colorado, New Jersey, and Oregon; the Capital District-Hudson Valley region of New York; the Cincinnati-Dayton region of Ohio; and the greater Tulsa region of Oklahoma.

The CPCI requires practices to implement methods similar to the Patient-Centered Medical Home model. Some of the features include providing patients with enhanced care coordination, 24/7 access, and, for patients with multiple conditions, additional care management.

The compensation structure is a blended payment of fee-for-service, per-patient-per-month care coordination fee, and shared savings bonuses for controlling costs, said Glen Stream, MD, president of the American Academy of Family Physicians (AAFP), in a statement. The Medicare care management fee will be $20 per Medicare beneficiary per month for the first 2 years and $15 per month in years 3 and 4, according to CMS. The AAFP estimated the management fee from commercial payers would range from $8 to $40 per patient, per month, and would be risk-adjusted based on a one-time retrospective look at the 3 years of prior claims data, according to an AAFP fact sheet.

The additional compensation will help participating primary care practices build and expand Patient-Centered Medical Home services with funds to invest in electronic health record technology and redesigned medical offices, Stream said.

Once CMS and commercial payers in each market reach an agreement, CMS will invite primary care practices in the markets to participate. Approximately 75 practices in each designated market will be selected to participate.

“We encourage family physicians in these regions to apply for participation in this initiative once CMS releases a solicitation notice to primary care practices in these areas,” Stream said. “This initiative is key to demonstrating the economic efficacy of care management fees for both Medicare beneficiaries and privately insured patients.”

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