President's Blog

I’m writing this from OMED 2011 in Orlando, where attendees learned more about the Center for Medicare and Medicaid Innovation’s multi-payer initiative focused on primary care.  This program, the Comprehensive Primary Care Initiative, is built on core elements of the patient-centered medical home, including:

• Enhanced access to care
• Coordinated care across the health system

This new initiative, which will be demonstrated in five to seven markets across the country, allows Medicare to work with commercial and state health insurance plans to provide bonus payments to primary care physicians.

For offering improved and comprehensive care, primary care physicians will receive a risk-adjusted, monthly care management fee on average of $20 per Medicare beneficiary per month during the first two years of the initiative.  The average per beneficiary per month payment drops to $15 for the third and fourth year.  After two years, all participating practices have the chance to share in a portion of the Medicare savings in their market.

For those serving Medicaid patients, additional reimbursement is available for newly initiated or enhanced primary care services that states wish to test as part of the program.

If you’d like your communities to be considered for this initiative, encourage the insurers (both public and private) that you work with to apply for this new program.  They must indicate their interest to the Centers for Medicare and Medicaid Services with a letter of intent to participate.  These letters must be received by Nov. 15.  The plan is to have selected the markets and fully implemented the program in these communities by summer 2012.

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