While the Comprehensive Primary Care Plus payment model has had some small impacts on improving quality, it also increased Medicare spending instead of lowering costs, a new independent report found.
The Centers for Medicare & Medicaid Services (CMS) released an annual independent review Wednesday of the first three years of the payment model. The review found primary care practices faced some major barriers to generating savings.
“It is still too early to draw conclusions about the likely longer-term effects of [CPC+],” according to the report conducted by research firm Mathematica.
The model includes 3,070 primary care practices that joined since it launched in 2017. The goal of the voluntary model is to provide two tracks that offer practices varying degrees of financial risk, with the second track asking providers to take on more risk.
CMS also partners with payers and health IT vendors to help practices make major changes in the efficiency and quality of care provided.
The model included enhanced payments to practices for participation. Participants in one of the tracks also get a lump-sum payment in lieu of traditional Medicare fee-for-service payments.
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The analysis found that over the first three years of the program, the model did not impact Medicare spending for usual expenditures, excluding the enhanced payments to providers.
But the model did increase Medicare expenditures by 2% for the first track and 3% for the second track when including those boosted payments, the report said.
“This increased spending for the CPC+ enhanced payments accounted for nearly all of the increases in Medicare costs,” the report added.
But there were small improvements of one percentage point or less on several quality measures in both tracks.
Some metrics that improved include the percentage of beneficiaries with diabetes that got recommended services, women that got breast cancer screenings and patient and caregiver engagement measures like those using hospice services.
“For some measures, there was little room for improvement, so it was not surprising that impacts were small,” the report said.
For example, more than 90% of beneficiaries in the model got an HbA1c blood sugar test in the year before the model began, so there wasn’t much room for improvement.
The model also did not impact hospital readmission rates.
But practices in the second track did have a more favorable effect on hospitalizations.
“However, track 2 practices also had a slightly larger increase in expenditures including enhanced payments than track 1 practices, reflecting CMS’ larger care management fees,” the report said.
One of the reasons could be that track 2 practices have more advanced care delivery requirements than those in the other track.
Mathematica also identified some factors that were out of primary care practices’ control that could have influenced the increase in costs and quality scores.
For instance, specialists and hospitals still operating in largely fee-for-service payment systems have an incentive to “deliver high-volume, high-cost care that can be a barrier to reducing Medicare expenditures,” the report said. “This underscores the need to engage other providers alongside CMS’ continuing efforts to bolster primary care progress toward a high-functioning healthcare system.”
The original Comprehensive Primary Care model also had issues generating savings for Medicare. A 2018 study found the program did lead to quality improvements but also didn't save Medicare money.