Private health plans in 7 regions have agreed to participate in a Centers for Medicare & Medicaid Services (CMS) effort to improve the U.S. primary care system.
The participants in the CMS Comprehensive Primary Care (CPC) program will work with CMS to pay primary care medical care practices to do a better of managing and coordinating care for all patients in the targeted communities, officials say.
The CPC program is similar to but separate from the two major CMS initiatives designed to test the “accountable care organization” (ACO) concept.
In an ACO, a patient’s personal physician acts as a “patient-centered medical home.” The “medical home” tries to take responsibility for ensuring that a patient gets the optimal amount of care. In return, the primary care physicians and other individuals and entities responsible for taking care of a patient may share some of the financial risk involved with managing the patient’s care.
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The CPC program calls for primary care physicians to set up medical homes, but it does not require the physicians to share financial risk with specialists and hospitals through ACOs.
Medicare will pay the providers a $20 monthly care management fee for each traditional Medicare enrollee in the medical home program. The medical home operators will get to split any savings Medicare gets as a result of the program, officials say.
The CMS medical home test program will start out operating in Arkansas, Colorado, New Jersey, New York, the Cincinnati-Dayton region in Kentucky and Ohio, Oklahoma and Oregon.