New CMS initiative increases Medicare payments to providers for coordinated care

October 4, 2011

The recently announced CMS Comprehensive Primary Care (CPC) Initiative will increase Medicare payments to primary care providers who adopt a coordinated care model. This model centers around teamwork between doctors, specialists and providers working together to prevent and manage chronic diseases. HHS officials expect this coordination to yield improved quality and cost savings.

The CPC demonstration project will take place in five to seven markets selected by the CMS. According to recent KHN article, “CMS is looking for areas with multiple interested insurers, both public and private. These insurers will then help target and select about 75 practices in each market.” The providers selected will receive $20 per month for each Medicare beneficiary during the first two years. They can use these funds at their own discretion to develop the infrastructure necessary to support coordinated care.

The CPC initiative will test two models at the same time: a service delivery model that will test comprehensive primary care, and a payment model where primary care practices will be paid a fee and could potentially share in Medicare savings generated. CMS will evaluate providers after a year and determine the amount of Medicare savings they will share.

This four-year CMS demonstration project will begin next year. Insurers who want to participate must submit a letter of intent by November 15, 2001. Applications are due January 17, 2012. After CMS selects the markets, solicitations for primary care providers in those markets will be issued. Funds should start going out in the summer of 2012. Over time, CMS expects to expand the coordinated care model to all patients.

For more information read these articles from CMS Innovations and Kaiser Health News.

Visit Extend Health — the nation’s largest private Medicare exchange.

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