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Cohen G, Duda N, Morrison-Lee K, Swankoski K, Giudice G, Palakal M, Mack C, O'Malley AS. How CPC+ supported patient care during the COVID-19 pandemic: Lessons for alternative payment models. Healthc (Amst) 2024; 12:100745. [PMID: 38603835 DOI: 10.1016/j.hjdsi.2024.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/09/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND A growing literature documents how primary care practices adapted to the COVID-19 pandemic. We examine a topic that has received less attention-how participants in an advanced alternative payment model perceive the model influenced their ability to meet patients' care needs during the pandemic. METHODS Analysis of closed- and open-ended questions from a 2021 survey of 2496 practices participating in the Comprehensive Primary Care Plus (CPC+) model (92% response rate) and a 2021 survey of 993 randomly selected primary care physicians from these practices (55% response rate). Both surveys asked whether respondents agreed or disagreed that they or their practice was "better positioned to meet patients' care needs during the coronavirus pandemic" because of participation in CPC+. Both also included an open-ended question about CPC+'s effects. RESULTS Half of practices and one-third of physicians agreed or strongly agreed that participating in CPC+ better positioned them to meet patients' care needs during the pandemic. One in 10 practices and 2 in 10 physicians, disagreed or strongly disagreed, while 4 in 10 practices and slightly more than half of physicians neither agreed nor disagreed (or, for physicians, didn't know). The most commonly identified CPC+ activities that facilitated meeting patient care needs related to practices' work on care management (e.g., risk stratification), access (e.g., telehealth), payment outside of fee-for-service (FFS), and staffing (e.g., supporting care managers). CONCLUSIONS Most CPC+ practices and physicians were positive or neutral about participating in CPC+ in the context of COVID-19, indicating more benefit than risk to payment alternatives to FFS.
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Affiliation(s)
- Genna Cohen
- Mathematica 1100 1st St NE 12th Floor Washington, DC, 20002-4221, USA.
| | - Nancy Duda
- Mathematica 600 Alexander Park, Suite 100, Princeton, NJ, 08543-2393, USA.
| | | | - Kaylyn Swankoski
- Mathematica 600 Alexander Park, Suite 100, Princeton, NJ, 08543-2393, USA.
| | - Gillian Giudice
- Mathematica 111 East Wacker Dr., Suite 3000, Chicago, IL, 60601, USA.
| | - Maya Palakal
- Mathematica 1100 1st St NE 12th Floor Washington, DC, 20002-4221, USA.
| | - Caroline Mack
- Mathematica 1100 1st St NE 12th Floor Washington, DC, 20002-4221, USA.
| | - Ann S O'Malley
- Mathematica 1100 1st St NE 12th Floor Washington, DC, 20002-4221, USA.
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Peikes D, Dale S, Ghosh A, Taylor EF, Swankoski K, O'Malley AS, Day TJ, Duda N, Singh P, Anglin G, Sessums LL, Brown RS. The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians. Health Aff (Millwood) 2018; 37:890-899. [PMID: 29791190 DOI: 10.1377/hlthaff.2017.1678] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.
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Affiliation(s)
- Deborah Peikes
- Deborah Peikes ( ) is a senior fellow at Mathematica Policy Research in Princeton, New Jersey
| | - Stacy Dale
- Stacy Dale is a senior researcher at Mathematica Policy Research in Chicago, Illinois
| | - Arkadipta Ghosh
- Arkadipta Ghosh is a senior researcher at Mathematica Policy Research in Princeton
| | - Erin Fries Taylor
- Erin Fries Taylor is a vice president and managing director of Health Policy Assessment at Mathematica Policy Research in Washington, D.C
| | - Kaylyn Swankoski
- Kaylyn Swankoski is a health analyst at Mathematica Policy Research in Princeton
| | - Ann S O'Malley
- Ann S. O'Malley is a senior fellow at Mathematica Policy Research in Washington, D.C
| | - Timothy J Day
- Timothy J. Day is a health services reseacher in the Research and Rapid-Cycle Evaluation Group, Center for Medicare and Medicaid Innovation, in Baltimore, Maryland
| | - Nancy Duda
- Nancy Duda is a senior survey researcher at Mathematica Policy Research in Oakland, California
| | - Pragya Singh
- Pragya Singh is a researcher at Mathematica Policy Research in Princeton
| | - Grace Anglin
- Grace Anglin is a senior researcher at Mathematica Policy Research in Oakland
| | - Laura L Sessums
- Laura L. Sessums is the director of the Division of Advanced Primary Care in the Seamless Care Models Group, Center for Medicare and Medicaid Innovation, in Baltimore, Maryland
| | - Randall S Brown
- Randall S. Brown is director of health research at Mathematica Policy Research in Princeton
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Abstract
This survey study examines the prevalence of and reasons for patient dismissal among primary care practices participating in the Comprehensive Primary Care initiative and a matched sample of comparison practices.
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Affiliation(s)
- Ann S O'Malley
- Mathematica Policy Research, Washington, DC2Mathematica Policy Research, Princeton, New Jersey
| | - Kaylyn Swankoski
- Mathematica Policy Research, Washington, DC2Mathematica Policy Research, Princeton, New Jersey
| | - Deborah Peikes
- Mathematica Policy Research, Washington, DC2Mathematica Policy Research, Princeton, New Jersey
| | - Jesse Crosson
- Mathematica Policy Research, Washington, DC2Mathematica Policy Research, Princeton, New Jersey
| | - Nancy Duda
- Mathematica Policy Research, Washington, DC2Mathematica Policy Research, Princeton, New Jersey
| | - Timothy Day
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Shannon Heitkamp
- Mathematica Policy Research, Washington, DC2Mathematica Policy Research, Princeton, New Jersey
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Dale SB, Ghosh A, Peikes DN, Day TJ, Yoon FB, Taylor EF, Swankoski K, O'Malley AS, Conway PH, Rajkumar R, Press MJ, Sessums L, Brown R. Two-Year Costs and Quality in the Comprehensive Primary Care Initiative. N Engl J Med 2016; 374:2345-56. [PMID: 27074035 DOI: 10.1056/nejmsa1414953] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. METHODS We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. RESULTS During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI], -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (P<0.001) and changes in two of the six domains of patient experience--discussion of decisions regarding medication with patients and the provision of support for patients taking care of their own health--both of which showed a small improvement in initiative practices relative to comparison practices (P=0.006 and P<0.001, respectively). CONCLUSIONS Midway through this 4-year intervention, practices participating in the initiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after accounting for care-management fees, nor have they shown an appreciable improvement in the quality of care or patient experience. (Funded by the Department of Health and Human Services, Centers for Medicare and Medicaid Services; ClinicalTrials.gov number, NCT02320591.).
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Affiliation(s)
- Stacy B Dale
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Arkadipta Ghosh
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Deborah N Peikes
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Timothy J Day
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Frank B Yoon
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Erin Fries Taylor
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Kaylyn Swankoski
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Ann S O'Malley
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Patrick H Conway
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Rahul Rajkumar
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Matthew J Press
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Laura Sessums
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
| | - Randall Brown
- From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.)
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