Dozens of commercial and government payers are now working with community groups and health information exchanges as part of an effort to use health information technology to enhance primary care through care coordination and patient-centered medical homes, the CMS announced
The goal of the Comprehensive Primary Care Initiative, which involves seven federally sponsored regional pilot sites nationwide, is to foster collaboration between public and private payers and offer bonus payments to participating primary-care physicians who better coordinate care for their Medicare and other patients.
Participating physicians—as many as 75 for each of the seven program regions—are expected to be named this month.
The CMS is sponsoring statewide initiatives in Arkansas, Colorado, New Jersey and Oregon and regional programs in New York, Ohio and Kentucky and Oklahoma.
The initiative will pilot-test service delivery models focused on care management, access to and continuity of care, planned and preventive care for patients with chronic conditions, improvements to patient and caregiver engagement and coordination of care "across the medical neighborhood," according to the CMS. Electronic health records will be used to support these pilot elements.
The pilot also will explore payment models involving management fees and shared savings.
"Each of the health plans participating is making a commitment to provide data to practices on cost of care, quality measure and data on utilization of services," said Susan Stuard, executive director of the Taconic Health Information Network and Community in New York. "That will be a whole new IT and data piece for the practices," she said, and will represent a challenge for the six participating plans in the New York pilot—Aetna, Capital District Physicians' Health Plan, Empire Blue Cross, Hudson Health Plan, MVP Health Care and Teamsters Multi-Employer Taft Hartley Funds—that have varying degrees of technological capabilities with regard to data conformity and platform sharing.
Physicians selected by the CMS, in contrast, should have a fairly level baseline of technological capabilities.
"What we have heard from CMS is that they need to have an electronic health record in place," Stuard said. In the THINC service area, there should be plenty of eligible practices, she said. According to a recent survey of THINC-area physician practices, a whopping 83% were using certified EHRs, Stuard said.
"We do think there is going to be strong interest," she said. "We expect that CMS is going to issue the applications in roughly the next two weeks."