Primary care physicians in seven insurance markets will soon have the chance to earn monthly bonus payments in exchange for offering longer hours and better care coordination.
Medicare, along with several private health plans, state Medicaid agencies, and self-insured employers, has agreed to pay primary care practices in certain regions a monthly care coordination fee if they provide additional services for patients. On average, the fee works out to about $20 per patient per month.
The idea behind the demonstration project is to provide payment for services that physicians aren’t currently reimbursed for or don’t have the time to provide, such as reviewing test results over the phone or helping patients to manage their weight.
To be eligible to participate, primary care practices must agree to offer a range of enhanced services including longer and more flexible hours, use of electronic health records, preventive care, coordination of care with other providers, helping patients and caregivers to manage their own care, and individualized care for patients with multiple chronic diseases, according to the Centers for Medicare and Medicaid Services (CMS).
The 4-year program, which is administered by the Center for Medicare and Medicaid Innovation, will be available in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley Region, Ohio’s and Kentucky’s Cincinnati-Dayton Region, and greater Tulsa, Okla. CMS will select about 75 primary care practices in each market to participate.
Practices interested in participating in the program must complete an online prescreen tool and an application. The deadline for applications is July 20.
CMS officials announced the Comprehensive Primary Care Initiative last September, and since then have been working to recruit private insurers to join in offering the care management. Overall, 45 commercial, federal, and state insurers will participate across the seven markets, according to CMS.
Practices are more likely to be selected for the program if they are already using a certified electronic health record system and have achieved state or national recognition as a patient-centered medical home, according to CMS. Practices that already participate in shared savings programs such as the Medicare Shared Savings Program, the Pioneer ACO Model, and the Independence at Home Demonstration Program are not eligible to participate.