Populations served by CPC+ medical home model are wealthier, use fewer inpatient services

October 01, 2018

When a new model of care delivery is introduced into the healthcare system an important measure of success is how well it aligns with population needs, and how well it serves those with the highest needs. Although such models have the potential to improve care for the nation's most vulnerable patients, evidence has shown that care delivery reform models could actually widen healthcare gaps across communities because doctors in areas with low resources may choose not to participate.

Researchers from The Dartmouth Institute for Health Policy and Clinical Practice examined participation in the Centers for Medicare & Medicaid Services' Comprehensive Primary Care Plus (CPC+) program to determine what types of practices joined the CPC+ model. The study also compared hospital service areas with and without CPC+ practices. The CPC+ model is a voluntary multipayer model that combines primary care redesign with efforts to restructure payment through prospective care management payments and performance-based incentives for care improvement. It is also the largest test by the CMS of an advanced primary care medical home model.

The research team compared CPC+ practices with other primary care practices operating within the 14 eligible regions that the CMS designated for participation. The CPC+ program operates statewide in 11 states and in select counties in 3 additional states.

Among the research team's findings recently reported in JAMA Network Open: "Although the goal of the program is to give practices more financial resources to make more flexible investments to improve the quality of care, our findings suggest the practices most in need of additional resources may not access them," said Dartmouth Institute research scientist and the study's lead author Taressa Fraze, PhD.

The researchers said that several features of the CPC+ model could contribute to this misalignment of the program with needs, including that clinics that serve vulnerable population, such as federally qualified health centers and rural health clinics, are excluded from the program.

"We could be looking at a bit of a cycle, in which practices that serve vulnerable populations have lower capacity and fewer resources to invest in in the intensive transformation activities the program model requires," Fraze said.
For the full study: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2703943

The Dartmouth Institute for Health Policy & Clinical Practice

Related Medicare Articles from Brightsurf:

Falling Medicare reimbursement rates for orthopaedic trauma
The amount Medicare reimburses for orthopaedic trauma surgery has fallen by nearly one-third over the past two decades, reports a study in the Journal of Orthopaedic Trauma.

Medicare coverage varies for transgender hormone therapies
A new study has shown substantial variability in access to guideline-recommended hormone therapies for older transgender individuals insured through Medicare.

Medicare changes may increase access to TAVR
The number of hospitals providing TAVR could double with changes to Medicare requirements.

Inequitable medicare reimbursements threaten care of most vulnerable
Hospitals, doctors and Medicare Advantage insurance plans that care for some of the most vulnerable patients are not reimbursed fairly by Medicare, according to recent findings in JAMA.

Medicare may overpay for many surgical procedures
For most surgical procedures, Medicare provides physicians a single bundled payment that covers both the procedure and related postoperative care over a period of up to 90 days.

Only 1 in 4 Medicare patients participate in cardiac rehabilitation
Only about 24% of Medicare patients who could receive outpatient cardiac rehabilitation participate in the program.

How common is food insecurity among Medicare enrollees? 
Nearly 1 in 10 Medicare enrollees age 65 and over and 4 in 10 enrollees younger than 65 with long-term disabilities experience food insecurity.

Medicare for All unlikely to cause surge in hospital use: Harvard study
Despite some analysts' claims that Medicare for All would cause a sharp increase in health care utilization, a new study finds the two biggest coverage expansions in US history -- Medicare and the ACA -- caused no net increase in hospital use.

Critical heart drug too pricey for some Medicare patients
An effective drug to treat chronic heart failure may cost too much for senior citizens with a standard Medicare Part D drug plan, said a study co-authored by a John A.

Research suggests strategy for more equitable Medicare reimbursement
Those who were enrolled in both Medicare and Medicaid were sicker, had more cognitive impairments and difficulty functioning, and needed more social support than those who were not enrolled in both government programs, Saint Louis University research found.

Read More: Medicare News and Medicare Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.