CMS follows lead of private payers by supporting primary care

July 1, 2012

Private insurers have created novel incentive programs this year to reinforce the practice of primary care.

NATIONAL REPORTS - Private insurers have created novel incentive programs this year to reinforce the practice of primary care. Last month, the Centers for Medicare and Medicaid Services (CMS) selected state agencies and partners in the private market to advance its Comprehensive Primary Care Initiative, which offers financial and operational support for primary care practices (PCPs).

In addition to the usual fee-for-service rates, CMS will pay a care management fee of $20 per-beneficiary, per-month to help support coordinated services. For PCPs to receive the care management fee, they must agree to provide specific enhanced services, such as using electronic health records and offering patients convenient evening or weekend appointments.

A total of 45 payers will participate in the federal initiative. WellPoint's affiliated plans in Colorado, Ohio and New York were selected by CMS.

Dr. Nussbaum says under the initiative WellPoint will implement best practices and leverage its experience with medical homes by enhancing the role of PCPs to oversee coordination of care for patients.

Approximately 75 primary care practices in each of CMS' seven designated markets will be selected to participate in the four-year project. According to CMS, 330,750 Medicare and Medicaid beneficiaries will be served by the participating practices. Physicians will be able to share in achieved savings.