The 500 medical practices participating in the CMS Comprehensive Primary Care Initiative are going to be under a lot of pressure, as it is now up to them to prove that the patient-centered medical-home model works clinically and economically.
Let's face it: Government-sponsored pilot programs and demonstration projects come and go. Most produce some headlines at their launch, then they generate a few research papers a year or three after their completion, and then they're forgotten.
But hopes are higher for the CPCI, which was described as "very well-conceived, well-designed and, so far, a well-executed program" by Patrick Gordon, program director for the Colorado Beacon Consortium and director of government programs for consortium member Rocky Mountain Health Plans based in Grand Junction, Colo., an area contending for the country's coordinated-care crown.
The key to the four-year effort is that around 60% of the patient bases for participating practices will be covered by plans providing per member, per month management fees. In the case of Medicare, it will be $20, with the fees for Medicaid and other participating private payers yet to be determined.
According to Gordon, it could "fundamentally change the economics of primary care" if the care coordination results in fewer hospitalizations and lower global costs to the country's healthcare bill.