Four years ago, in the early stages of the Affordable Care Act and the beginning of the shift from volume- to value-based reimbursement, Mercy Family Medicine in Durango, Colo., took a hard look at its future. The five-physician practice had just been acquired by the local hospital and was looking for the right practice model and payment structure for the future.
"We were looking at all aspects of healthcare, including the quality perspective, hospital operations, and reimbursement, as well as the landscape of integrating primary care with everything we do on the hospital side, not only to show quality, but also to reduce readmissions and all related factors," said Will McConnell, vice president of operations and outreach strategy, for Mercy Regional Medical Center.
After weighing possible participation in the Medicare Shared Savings Program, the practice instead looked at a new program from CMS called the Comprehensive Primary Care (CPC) Initiative. The four-year program aligns the federal agency with commercial and state payers in seven U.S. regions to offer population-based care management fees and shared-savings opportunities to participating practices around a core set of comprehensive primary care functions. Those include risk-stratified care management; access and continuity; planned care for chronic conditions and preventive care; patient and caregiver engagement; and coordination of care.
"In looking at the two programs [Medicare Shared Savings Program vs. CPC],
we decided that rather than wait for the final years and shared savings to kick in, we wanted to align ourselves with a pilot program that helped us establish the proper infrastructure, while trying to figure out how to actually deliver better care," said McConnell.
McConnell and Tamra Lavengood, CPC coordinator for Mercy Family Medicine and clinical performance coordinator for Centura Health Physician Group, both part of larger parent health system, Centura Health, will discuss their participation in the CPC initiative at the Health Information and Management Systems Society conference (HIMSS16) in Las Vegas, Nevada. Their session, "Comprehensive Primary Care: Our Success Story" is scheduled for Wed., March 2 at 10 a.m.
They recently spoke to Physicians Practice about the initial phases of the CPC Initiative and the importance of health IT in making the program work.