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CMS Announces Payer Commitments for Comprehensive Primary Care Initiative

EIGHT STATES, INCLUDING COLORADO, WILL TEST UNIQUE INVESTMENTS TO COORDINATE CARE

In a strong show of support for more effective, more affordable, higher quality health care, 45 commercial, federal and State insurers in seven markets today pledged to work with the Centers for Medicare & Medicaid Services (CMS) to give more Americans access to quality health care at lower cost.

Under the Comprehensive Primary Care initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services.  Simultaneously, participating commercial, State, and other federal insurance plans are also offering an enhanced payment to primary care practices that provide high-quality primary care. 

"We know that when we support primary care, we get healthier patients and lower costs," said Acting CMS Administrator Marilyn Tavenner, "This initiative shows that the public and private sectors can come together to meet the critical need for these services."

Insurers in Colorado, Arkansas, New Jersey, Oregon, New York’s Capital District-Hudson Valley Region, Ohio’s and Kentucky’s Cincinnati-Dayton Region, and greater Tulsa, Oklahoma signed agreements with CMS to participate in this initiative.  The markets were selected based on a diverse pool of applicants from commercial health plans, State Medicaid agencies, and self-insured businesses who hoped to work alongside Medicare to support comprehensive primary care.

In order to receive the new care management fee from CMS and insurers, primary care practices must agree to provide enhanced services for their patients, including offering longer and more flexible hours, using electronic health records; delivering preventive care; coordinating care with patients’ other health care providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

Approximately 75 primary care practices will be selected to participate in the Comprehensive Primary Care initiative in each designated market.  Interested primary care practices in each of the markets should complete the application pre-screen tool online at the Innovation Center’s website.  This is the first step in applying for the program.   Practices will not be allowed to submit an application without a completed application pre-screen tool.

In Colorado, CIVHC is acting as a resource for Colorado primary care practices and other organizations interested in CPCI. The Comprehensive Primary Care Initiative is a four-year initiative administered by the CMS Innovation Center.  Applications will be accepted until July 20.

For more information on the Colorado initiative and other resources including the application pre-screen tool, click here.

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