To support more effective, more affordable and higher-quality healthcare, 45 commercial, federal and state insurers in seven markets pledged to work with the Centers for Medicare & Medicaid Services to give more Americans access to quality healthcare at lower cost.
Under the Comprehensive Primary Care initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services. Participating commercial, state, and federal insurance plans also will offer a higher payment to primary care practices that provide high-quality care.
"We know that when we support primary care, we get healthier patients and lower costs," CMS Acting Administrator Marilyn Tavenner, RN, BSN, MHA, said in a news release. "This initiative shows that the public and private sectors can come together to meet the critical need for these services."
Insurers in Arkansas, Colorado, New Jersey, Oregon, the Capital District-Hudson Valley Region in New York, the Cincinnati-Dayton Region in Ohio and Kentucky, and greater Tulsa, Okla., signed agreements with CMS to participate in the initiative. The markets were selected based on having a diverse pool of applicants from commercial health plans, state Medicaid agencies and self-insured businesses that sought to work alongside Medicare to support comprehensive primary care.
To receive the new care management fees from CMS and insurers, primary care practices must agree to provide enhanced services for their patients, including: offering longer and more flexible hours; using electronic health records; delivering preventive care; coordinating care with patients’ other healthcare providers; engaging patients and caregivers in managing their own care; and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs.
Approximately 75 primary care practices will be selected to participate in the initiative in each designated market. Interested primary care practices in each of the markets should complete the application pre-screen tool online at the CMS Innovation Center’s website (http://bit.ly/Inrnhy). Applications will be accepted until July 20. The Comprehensive Primary Care Initiative runs for four years.
Under the Comprehensive Primary Care initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services. Participating commercial, state, and federal insurance plans also will offer a higher payment to primary care practices that provide high-quality care.
"We know that when we support primary care, we get healthier patients and lower costs," CMS Acting Administrator Marilyn Tavenner, RN, BSN, MHA, said in a news release. "This initiative shows that the public and private sectors can come together to meet the critical need for these services."
Insurers in Arkansas, Colorado, New Jersey, Oregon, the Capital District-Hudson Valley Region in New York, the Cincinnati-Dayton Region in Ohio and Kentucky, and greater Tulsa, Okla., signed agreements with CMS to participate in the initiative. The markets were selected based on having a diverse pool of applicants from commercial health plans, state Medicaid agencies and self-insured businesses that sought to work alongside Medicare to support comprehensive primary care.
To receive the new care management fees from CMS and insurers, primary care practices must agree to provide enhanced services for their patients, including: offering longer and more flexible hours; using electronic health records; delivering preventive care; coordinating care with patients’ other healthcare providers; engaging patients and caregivers in managing their own care; and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs.
Approximately 75 primary care practices will be selected to participate in the initiative in each designated market. Interested primary care practices in each of the markets should complete the application pre-screen tool online at the CMS Innovation Center’s website (http://bit.ly/Inrnhy). Applications will be accepted until July 20. The Comprehensive Primary Care Initiative runs for four years.
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