Tackling Skyrocketing Medical Costs with Alternative Payment Initiatives

HealthDay News – After 2 years, a large multipayer comprehensive primary care initiative was not found to be associated with Medicare Part A and B savings that could potentially cover program management costs, according to a study published in the New England Journal of Medicine.

Stacy Berg Dale, MPA, from Mathematica Policy Research in Chicago, and colleagues tracked changes in the delivery of care by practices participating in the Comprehensive Primary Care Initiative that was started in October 2012. Data were included for 497 primary care practices in seven regions across the United States.

The researchers found that initiative practices received a median of $115,000 per clinician in care-management fees during the first two years. Improvements were reported in approaches to the delivery of primary care in areas such as management of high-risk patients and enhanced access to care. 

There were no significant differences between initiative and comparison practices in terms of changes in average monthly Medicare expenditures per beneficiary, regardless of whether care-management fees were taken into account or not. Relative to comparison practices, initiative practices had a 3% reduction in primary care visits (P < .001) and small improvements in two of the six domains of patient experience.

The authors noted, however, that “the reduction in primary care visits, albeit a small contributor to total expenditures, suggests that nonbillable calls, e-mails, and interactions related to care management, supported by initiative fees, may have supplanted or reduced the need for office visits”.

Summary and Clinical Applicability

After 2 years, a large multipayer comprehensive primary care initiative was not found to be associated with Medicare Part A and B savings sufficient to cover management costs.

“As [the Centers for Medicare and Medicaid Services] increasingly pays for health care through alternative payment models that reward quality and value, the initiative may help inform future policies guiding models for primary care delivery in the United States,” the authors concluded.

This study was supported by the US Department of Health and Human Services and the Centers for Medicare and Medicaid Services.

Reference

Dale SB, Ghosh A, Peikes DN, Day TJ, Yoon FB, Taylor EF, et al. Two-Year Costs and Quality in the Comprehensive Primary Care Initiative. N Engl J Med. 2016; [Epub ahead of print] April 13, 2016. doi: 10.1056/NEJMsa1414953.