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Results From the Comprehensive Primary Care Initiative Highlight Challenges of Transforming Care

Laura Joszt
An analysis of the 4 years of the Comprehensive Primary Care Initiative found slowed growth in emergency department visits, but no significant changes in Medicare spending or claims-based quality of care.
Payer interest in new payment models and primary care delivery models has grown, and part of the movement has been models developed by CMS. Researchers from Mathematica Policy Research and the Center for Medicare and Medicaid Innovation have analyzed data after the 4 years of the Comprehensive Primary Care Initiative (CPC) to evaluate its impact on care delivery and outcomes, as well as spending trends.

The first 2 years of the model indicated no savings and little improvement in quality care; the study, published ahead of the June 2018 issue of Health Affairs, sought to evaluate the effects of CPC after the full 4 years.

“One concern with those interim results was that 2 years may have been insufficient time for practices to implement effective changes and for patients to experience improved outcomes,” the authors explained of the earlier results.

CPC required participating practices to implement 5 primary care functions, and they were supported with enhanced payments, data feedback on outcomes, and learning support. The practices that participated were chosen based on 7 regions selected by CMS. Within the regions, 502 practices were chosen, although 5 practices dropped out after selection. The researchers compared the 497 participating practices with a set of 908 comparison practices.

The researchers analyzed claims from 565,674 Medicare beneficiaries at CPC practices and 1,165,284 beneficiaries with comparison practices. They also analyzed utilization measures, such as annualized numbers of hospitalization and emergency department (ED) visits that did not lead to an admission, unplanned readmissions within 30 days after a hospitalization, and visits to specialists and primary care clinicians, in order to understand reasons for changes in spending.

Practices were also asked to score themselves on measures of practice care delivery and patient experience surveys were administered at months 8 to 12 and 45 to 48 of the model demonstration. Physician experience surveys were also administered at months 11 to 17 and 44 to 50.

The practices’ responses regarding care delivery suggest improvement, particularly in domains “measuring risk-stratified care management, access, and continuous improvement driven by data,” the authors found. While the comparison practices also reported improvements during this time, they were to a lesser degree. CPC practices did have a slower growth in ED visits and 30-day ED revisits. The largest gains in care delivery occurred during the first 2 years of CPC.

However, there was no significant difference shown in spending growth. There were also no significant improvements in patient experience, claims-based quality of care, or physician experience.

“Results from CPC illustrate how hard it is to reduce Medicare spending,” the authors wrote.

Reference

Peikes D, Dale S, Ghosh A, et al. The Comprehensive Primary Care Initiative: effects on spending, quality, patients, and physicians [published online May 23, 2018]. Health Aff (Millwood). doi: 10.1377/hlthaff.2017.1678.

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