Tens of thousands of patients to receive more coordinated care (August 22, 2012) The Innovation Center at the Centers for Medicare and Medicaid Services (CMS) has selected 75 area primary care medical practices to participate in its groundbreaking Comprehensive Primary Care initiative (CPC). The Greater

Cincinnati/Dayton/N. Kentucky region was one of seven selected nationwide to participate in this pilot program. It will test a new way of paying primary care practices that will leverage the doctor’s ability to be proactive about managing patients. The goal is to keep patients healthier, head off preventable illness and by doing so, preserve
health care dollars.

hospitals-quality-reformUnder CPC, 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 on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state, and other federal insurance plans are also offering enhanced payment to primary care practices that are designed to support them in providing high-quality primary care on behalf of their members. By way of example; a small practice with 2200 patients, 200 of them Medicare beneficiaries, can expect a revenue increase of $48,000 a year from Medicare and at least as much in enhanced payments from commercial insurers covering the remaining 2000 patients. The additional revenue is required to be invested in patient services. That may include hiring care coordinators and other staff to do patient outreach and guide patients with after-hours concerns. Patient are likely to have more access to last minute appointments and education services such as nutrition counseling and disease management coaching. Selected practices may also invest in improved technology to keep doctors and patients better connected.

“This is an important shift away from paying doctors based on the volume of patients
they see and finally focusing on quality and outcomes,” said Dr. Barbara Tobias, Medical
Director of the Health Collaborative, the area’s multi-stakeholder health care
improvement organization. “We now have the government and commercial plans paying
our doctors to keep people well, not just to treat them when they are sick. In the
medical profession we have always believed this is by far the best was to preserve
health care dollars.”
Ohio Medicare and nine commercial insurers are participating with Medicare. The plans
in the region with signed agreements are, Aetna, Amerigroup (Ohio only),
Anthem Blue Cross and Blue Shield of Ohio, Humana, UnitedHealthcare, CareSource
(Ohio only), HealthSpan, Medical Mutual, Centene Corporation (Ohio only), Ohio
Medicaid within the Ohio Department of Job and Family Services.
Practices were selected from a pool of applicants. Proficiency with electronic health
records (EHR) was a requirement. Selected practices will be expected to pull reports
from their (EHR) to manage patients and document their patient outcomes. This will
allow CMS and commercial insurers to measure the return on investment. A complete
list of selected practices is available on the Health Collaborative website, www.thecollaborative.org after 11:00 a.m. August 22, 2012.
“The eyes of the nation will be on Cincinnati as we work here to prove that keeping
people well and helping those with chronic conditions stay in control of their disease is
the best way to save Medicare dollars and bend the curve on health care spending for
everyone,” said Greg Ebel, Executive Director of the Health Collaborative. “We are so
proud that our physicians are already hard at work pioneering coordinated patient care
and because of that our commercial insurance plans saw our community as the right
place to test this important change in paying for health care.”
Practices will spend the next several months learning more about their patient
coordination and reporting requirements and signing agreements with the participating
payers. The schedule calls for the care management fees to begin to flow to the
practices by this November. In order to facilitate media coverage of this important announcement, the Health
Collaborative has a list of stakeholders who have agreed to make time in their schedule
today for media interviews. Please contact Laura Randall with your request at 513 979-
0051, or by email at lrandall@gchc.org.