Medicare to Participate in State Multi-payer Health Reform Efforts to Improve Quality and Lower Costs

States Urged to Join Demonstration

WASHINGTON--(BUSINESS WIRE)-- The Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) today invited states to apply for participation in the Multi-payer Advanced Primary Care Practice Demonstration, an initiative in which Medicare will join Medicaid and private insurers in state-based efforts to improve the delivery of primary care and lower health care costs.

“Advanced Primary Care practices are one of our most promising models for improving the quality of care and bringing down health care costs across the country,” said HHS Secretary Kathleen Sebelius. “By having Medicare participate in these demonstration projects, for the first time ever, we’ll help these innovative models spread and take another big step towards building a health care system that works better for all Americans.”

An Advanced Primary Care (APC) practice, commonly referred to as the patient-centered medical home, is a leading model for efficient management and delivery of quality health care services. APC practices promote accessible, continuous, and coordinated family-centered care utilizing a team approach and emphasizing prevention, health information technology, care coordination and shared decision making among participating patients and their providers.

The demonstration is an opportunity to assess the effect of advanced primary care practice, when supported jointly by Medicare, Medicaid, and private health plans, on:

  • The safety, effectiveness, timeliness, and efficiency of health care;
  • Assuring access and appropriate utilization of services covered by Medicare, Medicaid, and private health plans, while lowering expenditures;
  • The ability of beneficiaries to participate effectively in decisions concerning their care; and,
  • The delivery of care consistent with evidence-based guidelines.

“This demonstration will mark the first time that Medicare, Medicaid and private insurers will join in a partnership with states to transform health care delivery,” said Marilyn Tavenner, acting CMS administrator and chief operating officer. “Enabling public and private providers to work together will provide a valuable opportunity to strengthen our health care system and improve the quality of care for people with Medicare, Medicaid, and private insurance. Improved efficiencies in the system could mean providers will be able to spend more time with their patients, provide higher quality care, and better coordinate that care with other medical professionals.”

To be eligible, states will need to demonstrate that they can meet certain requirements, including having a state agency responsible for implementing the program, being ready to make payments to participating practices six months after being selected for participation, and having mechanisms in place to connect patients to community-based resources.

CMS anticipates making awards to up to six states and will perform an independent evaluation of the projects conducted under this demonstration.

Demonstrations like the Multi-Payer Advanced Primary Care Practice allow CMS to test and validate innovative new models of health care delivery and to translate insights and lessons learned into future policy and program redesign. This demonstration is an example of the sort of programs that CMS will carry out under the Center for Medicare and Medicaid Innovation, which was authorized in the Affordable Care Act and will be in place no later than Jan. 1, 2011. The new center will allow CMS to significantly expand the portfolio of innovative demonstrations that will drive cost effectiveness and quality improvement in the health care system during the coming years.

Information on the demonstration, including the solicitation can be found on the demonstration Web site:

Note: All HHS press releases, fact sheets and other press materials are available at


HHS Press Office

KEYWORDS:   United States  North America  District of Columbia

INDUSTRY KEYWORDS:   Health  Public Policy/Government  Healthcare Reform  Public Policy  White House/Federal Government  General Health