A new study whose results were published n the September issue of Health Affairs casts considerable doubt on the Comprehensive Primary Care Plus (CPC+) model’s ability to lower spending and control costs, despite the hope that had been invested in it. This study focused on the populations managed by two private health insurers in Michigan, as was authored by Adam A. Markovitz, Roslyn C. Murray, and Andrew M. Ryan, Ph.D., all of the University of Michigan.
The abstract of “Comprehensive Primary Care Plus Did Not Improve Quality Or Lower Spending For The Privately Insured,” reads thus: “Comprehensive Primary Care Plus (CPC+) was a multipayer payment reform model that provided incentives for primary care practices to lower spending and improve quality performance. Although CPC+ has been evaluated in Medicare, little is known about its impact in the private sector. Using claims and enrollment data from the period 2013-20 from two large insurers in Michigan, we performed difference-in-differences analyses,” the researchers from the University of Michigan write, “and found that CPC+ was not associated with changes in total spending (-$44.70 per year) or overall quality performance (-0.1 percent point). These changes did not vary systematically across CPC+ cohorts, tracks, regions, or participation in prior primary care innovations. We conclude,” they write, “that CPC+ did not improve spending or quality for private-plan enrollees in Michigan, even before accounting for payouts to providers. This analysis adds to existing evidence that CPC+ may cost payers money in the short term, without concomitant improvements to care quality.”
As the researchers write, “Primary care is essential to a high-functioning health system. It is central to preventive care and the logical home for care coordination and chronic disease management. Yet prevailing fee-for-service payment in the United States does not reward this kind of patient management and coordination. For these reasons, reforming primary care payment and delivery is a key focus of national reforms. In 202 the Center for Medicare and Medicaid Innovation (CMMI) initiated the Comprehensive Primary Care (CPC) initiative, a multipayer reform that provided primary care practices with monthly care management fees and opportunities for bonuses Evaluations of CPC found that the program did not generate enough savings to offset practice payouts, nor did the program substantially improve quality of care for Medicare beneficiaries. This prompted CMMI to launch CPC Plus (CPC+) in 2017, which gives practices the opportunity to shift toward flexible hybrid fee-for-service payments and fixed quarterly per member payments intended to facilitate care delivered outside of face-to-face encounters. Practices are also eligible for financial incentives based on health care use and quality performance. Findings from Medicare-focused evaluations of CPC+ have been consistent with those from CPC evaluations in showing minimal impact on spending or quality.”
The question, as the researchers note, is whether CPC+-based reimbursement supports advances on the private side. “Private insurers have advantages over Medicare that might allow them to respond more robustly to CPC+ initiatives. Private payers have fewer restrictions on using benefit and network design to reduce costs—for example, steering enrollees toward in-network providers or requiring primary care physician referrals. They may also better tailor value-based payment programs to local markets. However, Medicare-led reforms such as CPC+ might not align as well with private payers’ existing programs, thus reducing the effectiveness of those reforms.”
In fact, the authors of the article go in considerable detail over their findings, concluding that, “In this study of the effect of Comprehensive Primary Care Plus on spending and quality for enrollees n private plans in Michigan, we report three main findings. First, CPC+ was not associated with reductions in total spending or most components of spending. Second, CPC+ was not associated with improvements in overall quality performance or any of the six individual quality performance measures. Third, changes in spending and quality did not vary systematically across CPC+ cohorts, CPC+ tracks, regions, or participation in prior primary care innovations.”
Ultimately, they write, “Our study suggests that CPC+ did not improve spending and quality performance for private-plan enrollees in Michigan, even before accounting for payouts. This analysis adds to existing evidence that CPC+ may have cost private payers money in the short term without concomitant improvements to care quality. More research is needed to determine the potential for value-based reforms to improve spending and quality of care in the private market.”
