Update on the 'Comprehensive Primary Care Initiative'
Two years into the Comprehensive Primary Care Initiative showed that the delivery of primary care has improved, but expenses and patient experiences have not.
According to a study in the New England Journal of Medicine, practices reported significant improvements in the delivery of primary care halfway through the Comprehensive Primary Care Initiative -- but Medicare expenditures and patient experience have seen little change.
The Comprehensive Primary Care Initiative is testing several forms of support in 497 primary care practices in the United States to determine whether they can improve the quality of care and reduce costs.
Participating primary care practices were required to make changes in care delivery to improve 5 functional areas:
- Access to and continuity of care
- Planned care for preventive and chronic needs
- Risk-stratified care management
- Engagement of patients and their caregivers
- Coordination of care with patients' other care providers
To support the practices' efforts, the initiative provided care-management fees, allowed providers to earn shared savings, gave data feedback, and provided learning support.
At the 2-year midpoint of the initiative, the researchers compared changes in Medicare expenditures, health care use, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries in initiative practices and a group of matched comparison practices.
The researchers assessed practice transformation with a 37-item survey from a care-delivery module that each participating practice self-scored on a scale of 1 to 12 points, with higher scores reflecting better delivery of primary care. To determine patient experience outcomes, 2 rounds of patient surveys were sent by mail and included 6 domains of the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Patient-Centered Medical Home Survey.
Initiative practices received a median of $115,000 per clinician in care-management fees.
The initiative practices' survey scores suggested significant improvement, with average scores increasing from 6.5 at baseline to 8.8 after 2 years. Risk-stratified care management and access to care saw particularly significant increases in average scores from baseline to 2 years, increasing from 4.6 to 9.7 and from 7.0 to 9.6, respectively.
There were no significant differences between initiative and comparison practices in changes in average monthly Medicare expenditures per beneficiary, both when care-management fees were taken into account and when they were not.
The initiative practices had a 3% reduction in primary care visits, compared with control practices. The initiative practices also saw small but significant changes in 2 of 6 domains of patient experience (discussion of decisions about medications with patients and providing support for patients taking care of their own health), compared with control practices.
This analysis includes data from the first half of the initiative, and the researchers note that a final analysis will ultimately determine the effect of these interventions.
- Berg Dale S, Ghosh A, Peikes DN, et al. Two-year costs and quality in the comprehensive primary care initiative. N Engl J Med. Published online April 13, 2016. doi:10.1056/NEJMsa1414953.