Denver, CO, April 16 – Colorado is one of just seven markets nationwide selected by the Centers for Medicare and Medicaid Innovation (CMMI) for the Comprehensive Primary Care Initiative (CPCI). This landmark, four-year, multi-payer project aims to strengthen the primary care system while improving health care outcomes and controlling costs through a patient-centered medical home (PCMH) approach. Project launch is conditional on the signing of memoranda of understanding between CMMI and each participating payer.
Seven Colorado commercial plans, as well as the state’s Medicaid office, applied to participate in CPCI. Those payers are:
- Anthem Blue Cross Blue Shield
- Rocky Mountain Health Plans
- San Luis Valley HMO
- Colorado Access
- Colorado Medicaid
Medicare will work collaboratively with these payers to make significant “care coordination” payments to primary care practices to support enhanced primary care services for their patients. These services include: improved care coordination; increasing patients’ access to care; delivering preventive care; engaging patients and caregivers in managing their own care; providing individualized, enhanced care for patients living with multiple chronic diseases and other complex needs.
Participating providers will then be able to share in the savings generated by this approach.
Phil Kalin, CEO of the Center for Improving Value in Health Care, pointed out, “We know that approximately 30 percent of the dollars we spend on health care don’t add value. A key opportunity to change that is better coordination of care through approaches such as PCMH that incent physicians to keep people healthy and bend the cost curve.”
Upon completion of the memoranda of understanding, Medicare will select approximately 75 primary care practices around the state to participate in the program and receive these care management payments. Payments to providers are slated to begin in the fall of this year.
“Colorado was ideally positioned for CPCI because many of the health plans, as well as Medicaid, were already participating in a four-year, multi-payer PCMH pilot,” noted Marjie Harbrecht, MD, CEO of HealthTeamWorks, which managed that pilot; Harbrecht was instrumental in Colorado’s CPCI application. “They’ve seen great outcomes from that pilot, and understand the value of working with primary care practices in this way.”
Ben Price, CEO of the Colorado Association of Health Plans, agreed and commented, “Colorado’s health plans have been committed to working together on common strategies for improving quality and controlling costs. So a joint effort like CPCI was an opportunity our members got behind quickly."
Kalin picked up on this theme, noting, “The type of collaboration the CPCI requires has been evident from the beginning of this process. CIVHC and HealthTeamWorks together convened the payers and gave them the data they needed for strong applications. And the payers demonstrated a real willingness to work with the provider community on this initiative. From CIVHC’s perspective, this is part of our broad efforts to move toward payment mechanisms that reward outcomes, improve health and control costs.”
For more information about the CPCI, visit innovation.cms.gov/initiatives/comprehensive-Primary-Care-Initiative.
About HealthTeamworks, CIVHC and CAHP
For more information visit our websites: HealthTeamWorks (www.healthteamworks.org); CIVHC (www.civhc.org); CAHP (www.colohealthplans.org)