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Outcomes With the Comprehensive Primary Care Plus Model

The largest U.S. primary care delivery model ever tested, the Comprehensive Primary Care Plus (CPC+) met some goals related to the theory of change and improved early focus on episodic care. Still, its use was not associated with a reduction in total expenditures over 5 years, a study shows. “Positive interaction between CPC+ and the Shared Savings Program suggests transformation models might be more successful when provider cost-reduction incentives are aligned across specialties,” the authors conclude. “Further adaptations and testing of primary care transformation models, as well as consideration of the larger context in which they operate, are needed.”

The CPC+ model was launched using a 2-track design in 2017 by CMS. Seeking to provide more robust support to primary care practices, including partial capitation during track 2, the model provided care management fees and practice-level performance-based incentive payments.

Based on a prespecified primary outcome of annualized Medicare Part A and B expenditures per beneficiary per month (PBPM), analysis of the model showed the following: “Among the CPC+ patients, 5% were Black, 3% were Hispanic, 87% were White, and 5% were of other races (including Asian/Other Pacific Islander and American Indian); 85% of CPC+ patients were older than 65 years and 58% were female. CPC+ was associated with no discernible changes in the total expenditures (track 1: $1.1 PBPM [90% CI, –$4.3 to $6.6], P = .74; track 2: $1.3 [90% CI, −$5 to $7.7], P = .73), and with increases in expenditures including enhanced payments (track 1: $13 [90% CI, $7 to $18], P < .001; track 2: $24 [90% CI, $18 to $31], P < .001). Among secondary outcomes, CPC+ was associated with decreases in emergency department visits starting in year 1, and in acute hospitalizations and acute inpatient expenditures in later years. Associations were more favorable for practices also participating in the Medicare Shared Savings Program and independent practices. CPC+ was not associated with meaningful changes in claims-based quality-of-care measures.”

Source: JAMA