Evaluation of the Comprehensive Primary Care Initiative

Study Overview
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Brief Summary
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This study assesses the effects of the Centers for Medicare and Medicaid Services' Comprehensive Primary Care (CPC) initiative on physician practices, practice staff, Medicare and Medicaid costs and service utilization, quality of care, and patient outcomes. CPC provides financial resources, timely feedback on key practice outcomes, and a learning network to support practice transformation to improve quality of care and lower costs.

Detailed Description
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CMS selected 7 regions (states or substate areas) to include in this study, based on commitment of other (ie, nonMedicare) payers in the area to provide financial resources to participating practices to support practice transformation to improve quality of care, reduce costs, and improve population health. 497 practices were selected from roughly 1000 applicants in the 7 regions to participate in the study. CMS pays participating practices a per member per month care management fee for each Medicare patient attributed to the practice. The practices also receive quarterly feedback on trends in their Medicare patients' use of hospital and emergency room services, Medicare expenditures, and patient outcomes from periodic surveys. Practices are expected to improve patient outcomes and lower Medicare costs per patient by using the additional resources to improve: risk-stratified care management, access and continuity of care, planned chronic and preventive care, patient and caregiver engagement, and coordination across the medical neighborhood. To remain in the study, practices must meet annual milestones for meaningful use of electronic health records and other practice features. The intervention period, which began in Fall 2012, will continue for 4 years.

Official Title
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Evaluation of the Comprehensive Primary Care Initiative

Conditions
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Medicare Expenditures, Quality of Care

Intervention / Treatment
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* Other: care management fee
* Other: feedback reports
* Other: technical assistance


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Medicare beneficiary attributed to CPC practice or to a matched comparison practice. Patients are attributed to the practice from which they received the most E&M visits during the 2-year period examined. Exclusion Criteria: Beneficiaries enrolled in a managed care plan.

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment group<br>Practices assigned to the treatment group received per member per month care management fees for each Medicare beneficiary attributed to their practice. They also received quarterly feedback reports on their patients' average Medicare expenditures and use of hospital and emergency room services. Practices also had access to regional learning faculties for technical assistance with transformation activities and to share lessons across practices. | Other: care management fee<br>* for each Medicare beneficiary attributed to the practice, the practice received a monthly care management fee<br>Other: feedback reports<br>* Each participating practice received quarterly reports showing the practice's trend in key outcomes during the pre-intervention and intervention periods. The risk adjusted average Medicare expenditures of their patients were also shown in relation to all of the other CPC practices in their region, and to those with a similar average risk profile. Unadjusted hospitalization rates and emergency room visits were also plotted over time and compared to those of other CPC practices in the region<br>Other: technical assistance<br>* CPC practices could ask for technical assistance on transformation activities from a regional learning faculty (RLF). The RLF also provided seminars and other learning activities, as well as provided a forum for participating practices to share lessons they had learned.<br>|
| No Intervention: Comparison group<br>Within each of the 7 regions, this group is comprised of practices that were matched to the treatment practices on a wide range of baseline characteristics of the practices (including their service utilization patterns) and their patients. Comparison practices were selected from a pool of practices including those that applied to participate but were not selected, and practices serving nearby external comparison areas. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Medicare expenditures | average Medicare expenditures per month in Medicare fee-for-service | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of ER visits | number of emergency room visits that did not result in a hospital admission | 12 months | 
| number of hospital admissions | number of admissions to general acute short term hospitals during the followup period | 12 months | 
| 30-day hospital readmission rate | whether readmitted to the hospital within 30 days after discharge | 30-days | 
| hospital admission for ambulatory care sensitive condition | whether admitted to hospital for a condition classified as being sensitive to the quality of ambulatory care received | 12 months |