Julie Schilz leads private sector health offerings and business development at Mathematica Policy Research. Her editorial comments on the CPC evaluation reflect her perspective and broad knowledge base of care management, quality improvement, value-based reimbursement programs, and medical home initiatives, including those led by the Centers for Medicare & Medicaid Services and the Center for Medicare & Medicaid Innovation. Prior to coming to Mathematica, she was staff vice president for care delivery transformation at Anthem.
Despite seminal research from Barbara Starfield highlighting its value, primary care remains underemphasized relative to other parts of the health care system in the United States. But payers increasingly agree on the need to strengthen primary care to help reduce costs and improve care.
The Centers for Medicare & Medicaid Services’ Comprehensive Primary Care (CPC) initiative was designed to advance these goals. It aimed to test whether a core set of five primary care functions combined with multipayer payment reform, data-driven continuous improvement, learning supports, and meaningful use of health information technology “can achieve improved care, better health for populations, and lower costs, and can inform future Medicare and Medicaid policy.”
Mathematica’s recently completed evaluation of the CPC initiative highlights how it influenced approaches to strengthening primary care. The evaluation examined Medicare fee-for-service beneficiaries’ quality of care, cost, and patient experience, as well as provider experience. Although the impact results were not as positive as we had all hoped, the favorable implementation findings might lay the foundation for better outcomes over time. Two important factors in particular might shape the future success of ongoing efforts in CPC regions.
All health care is local, and CPC fostered substantial local collaboration. The approach of CPC was to “think globally but act locally” to impact the care delivered to Medicare beneficiaries, patients of other participating payers, and the other patients served by participating practices. In the selected regions, payers and practices came together to collectively work on solutions. This is a significant departure from prior initiatives in which everyone had ideas about solutions based on where they sat at the health care table. Payers are now working together in communities to build primary care capacity. In some regions, payers collectively funded community resources such as data aggregation to drive success. Payers and practices are now working together to discuss what works and what needs to be improved. All CPC regions are sharing the lessons learned and best practices to drive further innovation.
CPC put patients and families at the center of primary care. CPC did not require practices to be or to become patient-centered medical homes (PCMHs), but it did emphasize many attributes of the PCMH in the model. CPC was launched on the heels of several years of PCMH pilots that started to test practice transformation. Initially, however, the patient voice was not always at the center of many of these medical home efforts. CPC served as an additional catalyst for patient- and family-centered approaches by requiring Patient and Family Advisory Councils or patient surveys to drive quality improvement within the practices. The work done by CPC regions has indirectly helped support additional initiatives such as Partnership for Patients and the current administration’s work on Patients Over Paperwork.
The research that led payers to test primary care models such as CPC and now Comprehensive Primary Care Plus is driving primary care in the right direction. But it is incumbent on us all to take the lessons learned and translate them into innovative thinking that creates the health care delivery system we all agree is needed: one with a strong foundation of primary care.
