The Cincinnati/Dayton Region has been selected to participate in a groundbreaking health care initiative called The Comprehensive Primary Care Initiative (CPCi). It has the potential to completely change the way primary care is delivered in up to 75 medical practices in Greater Cincinnati and Dayton. The program from the Center for Medicare and Medicaid Innovation (CMMI) will invest somewhere in the amount of $15-million per year, for four years, in new Medicare funds to support new approaches to primary care in the selected practices in the Cincinnati/Dayton region. In addition, commercial insurance plans have committed to make similar investments and Ohio Medicaid may also elect to participate.

Under the plan, in addition to traditional fee for service reimbursement from Medicare and other payers selected practices will receive a patient management fee averaging $20 per month for each Medicare patient in the practice. As partners in the program, the selected commercial health insurers will also contribute in a similar manner for their covered patients. Primary care doctors will be expected to use these resources to put
systems in place to enhance care coordination for their challenging patients who would benefit from more intervention and to better manage every patient’s care before, during, and after episodes of illness. The prediction is that patients in these practices will have fewer emergency room visits, and fewer hospital stays, with an end result of healthier patients and a lower overall cost of care. Cincinnati/Dayton is one of seven regions selected for this four-year program. In its entirety, the one-billion dollar investment by CMMI in the CPCi program is estimated to save Medicare l0-billion dollars.

The Cincinnati/Dayton region owes the success of this application to area health insurance providers. They had to formally commit their willingness to partner, by funding the selected primary care practices in a similar manner. The insurance providers making that commitment are Anthem Blue Cross and Blue Shield, Buckeye Community Health Plan, HealthSpan, Humana, Medical Mutual of Ohio and UnitedHealthcare. Ohio Medicaid is also expected to support the initiative.

“This new program is a game changer,” says Greg Ebel, executive director at the Health Collaborative. “It will mean that doctors will get paid for being proactive in their efforts to keep their patients as healthy as possible as opposed to the current system, in which doctors have little contact with patients until they arrive sick at the practice office.”

Ebel also noted his gratitude to the commercial insurance companies for securing the selection of the region by articulating the area’s readiness for a program of this nature. “Greater Cincinnati and Dayton was selected because our commercial insurance plans were able to point to collaborative efforts by a variety of stakeholders already underway to support comprehensive primary care using the Patient-Centered Medical Home model as well as integrated technology, outcome measurement systems, and support for payment models that reward healthier patient outcomes.”

Only broad practice eligibility requirements are known at this time. The Solicitation from CMMI included the following information.

  1. Eligible practices must be predominantly primary care practices, (family medicine, internal medicine or geriatric medicine).
  2. Must be located in the 13 county Southwest Ohio Region selected for this project.
  3. Have a minimum of 200 eligible Medicare beneficiaries.
  4. Use an electronic health record (EHR) system or electronic registry. Preference will be given to practices that have achieved first stage meaningful use in the Medicare EHR Incentive program.

Also broadly discussed are the expectations for the selected practices. Selected practices will be expected to demonstrate their commitment to using technology to help meet the following goals.

  1. Put a system in place to indentify high-risk, high-need patients and develop plans to intervene with an appropriate care management plan for each patient.
  2. Provide access to a designated care provider and EHR records on a 24/7 basis.
  3. Provide proactive assessments, planned care for chronic conditions, and pharmaceutical management.
  4. Coordinate patient care across other providers and other health settings.
  5. Develop programs to engage and educate patients and care givers, making them partners in their care decisions.

The applications will be made to CMMI and that period is expected to transpire during June and July of 2012. Selections will be made at the federal level with the program planned to begin in October. An additional source of information is the CPCi Website.

The Health Collaborative has retained services to help coordinate information to stakeholders. Deadlines, selection criteria, reporting requirements and other important information will be released when they become available.

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The Health Collaborative assembles diverse community stakeholders; hospitals, physicians, insurers, patients, business, education, government and community members, with the goal of generating measurable, sustainable health improvement. The work of the Collaborative has been recognized by the U.S. Department of Health & Human Services, the Agency for Healthcare Research and Quality, and the Robert Wood Johnson Foundation. For more information, visit www.the-collaborative.org.

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