CMS solicits payors for primary care effort

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The Center for Medicare & Medicaid Innovation Center has set in motion its new initiative, the Comprehensive Primary Care (CPC) effort, a multi-payor initiative fostering collaboration between public and private healthcare payors for primary care. The Innovation Center now is accepting letters of intent from public and private healthcare payors for the initiative.

The CPC initiative will test two models simultaneously: a service delivery model and a payment model. The service delivery model will test comprehensive primary care, which is characterized with the following five functions:

  1. Risk-stratified care management;
  2. Access and continuity;
  3. Planned care for chronic conditions and preventive care;
  4. Patient and caregiver engagement;
  5. Coordination of care across the medical neighborhood.

The payment model includes a monthly care management fee paid to the selected primary care practices on behalf of their fee-for-service Medicare beneficiaries and, in the second through fourth years of the initiative, the potential to share savings to the Medicare program, according to an announcement by the Innovation Center. Practices will also receive compensation from other payors participating in the initiative, including private insurance companies and other health plans, which will allow them to integrate multi-payor funding streams to strengthen their capacity to implement practice-wide quality improvement.

The first step is for public and private payors (including states) to indicate their interest to the Centers for Medicare & Medicaid Services (CMS), including the level and type of support for primary care practices being offered. Interested payors must submit a nonbinding letter of intent and a geographic service area worksheet by Nov. 15. Applications from payors that do not submit a letter of intent will not be considered.

Final applications, to be completed only after the letter of intent has been submitted, must be received on or before Jan. 17, 2012. Once CMS evaluates these proposals and selects the markets, a second solicitation will be issued for primary care practices in those markets.

Download the full CPC initiative solicitation (PDF) here.