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CMS Makes Private-Sector Committments to Improve Primary Care for Patients

June 12, 2012

In support of more effective, affordable, and higher quality healthcare, 45 commercial, federal and state health insurers in seven markets will work with the Centers for Medicare & Medicaid Services (CMS) to give more Americans access to quality healthcare at lower cost.

Under the Comprehensive Primary Care initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services. Simultaneously, participating commercial, state and other federal insurance plans are also offering an enhanced payment to primary care practices that provide high-quality primary care.

“We know that when we support primary care, we get healthier patients and lower costs,” said Acting CMS Administrator Marilyn Tavenner. “This initiative shows that the public and private sectors can come together to meet the critical need for these services.”

Health insurers in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley region, Ohio’s and Kentucky’s Cincinnati-Dayton Region, and Tulsa, Oklahoma have agreed with CMS to participate. The markets were selected based on a diverse applicants from commercial health plans, state Medicaid agencies, and self-insured organizations who plan to work with Medicare to support comprehensive primary care.

In order to receive the care management fee from CMS and health insurers, primary care practices agree to provide enhanced services for their patients, including offering longer and more flexible hours, using EHrs; delivering preventive care; coordinating care with patients’ and other healthcare providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

Approximately 75 primary care practices will be selected to participate in the Comprehensive Primary Care initiative in each market. Interested primary care practices in these markets should complete the online application pre-screening tool at the Innovation Center’s website. This is the first step in applying for the program. Practices will not be allowed to submit an application without a completed pre-screen application.

The Comprehensive Primary Care initiative is a four-year initiative administered by the Innovation Center. Applications are being accepted until July 20.

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