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Numerous Payers Selected for CMS’ Coordinated Care Initiative

June 8, 2012
by Gabriel Perna
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Forty-five commercial, federal and State insurers made a pledge to work with the Centers for Medicare & Medicaid Services (CMS) in its Comprehensive Primary Care initiative, which aims to give more Americans access to quality healthcare at lower cost. Under the initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services. 

As part of the new agreement, participating plans are offering an enhanced payment to primary care practices that provide high-quality primary care.   "We know that when we support primary care, we get healthier patients and lower costs," Acting CMS Administrator Marilyn Tavenner said in a statement. "This initiative shows that the public and private sectors can come together to meet the critical need for these services."

The 45 insurers are in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley Region, Ohio’s and Kentucky’s Cincinnati-Dayton Region, and greater Tulsa, Oklahoma. The groups signed agreements with CMS to participate in this initiative and were selected based on a diverse pool of applicants from commercial health plans, State Medicaid agencies, and self-insured businesses who hoped to work alongside Medicare to support comprehensive primary care.

The care management fee will come from primary care practices providing enhanced services for their patients, including offering longer and more flexible hours, using electronic health records; delivering preventive care; coordinating care with patients’ other health care providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

CMS will choose 75 primary care practices will be selected to participate in the Comprehensive Primary Care initiative in each designated market.  Interested primary care practices in each of the markets should complete the application pre-screen tool online at the Innovation Center’s website. Applications will be accepted until July 20.

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