Data on CPC+ in Oregon Shows Primary Care Quality Improvement
A newly released analysis from the Milbank Memorial Fund found several positive impacts for practices participating in the federal Comprehensive Primary Care Initiative (CPC Classic) and the follow-on CPC+ programs in Oregon.
The analysis examined data on quality, utilization, and cost from the 62 Oregon primary care practices that participated in CPC Classic and continued with the CPC+ program in 2017, and compared these with Oregon primary care practices that participated in CPC Classic only or did not participate in either program.
In 2017, practices participating in both programs performed better across all payer types than practices in the comparison group on 24 of 26 quality measures, including breast and cervical cancer screening and several chronic disease measures, the researchers found.
Practices that participated in both programs also showed positive trends in emergency department utilization and avoidable emergency department utilization across all payer types. In addition, CPC-participating practices had lower per member per month adjusted claims-based costs among commercially insured members for numerous service types.
Oregon was one of 18 regions selected by the Centers for Medicare & Medicaid Services (CMS) to join the CPC program, which began in 2017. Oregon also participated in CPC+, which the report notes is consistent with many of Oregon’s delivery system innovations, which include greater investments in primary care along with an emphasis on increased adoption of value-based payment models.
Both the CPC Classic and CPC+ models require primary care practices to change the way they deliver care, with a focus on key functions such as care management, population health, and comprehensiveness and coordination. The CPC+ model also aligns with the contractual value-based payment requirements for Oregon’s Coordinated Care Organizations.
A group of payer organizations, called the Oregon CPC+ Payer Group, came together to meet the CPC+ participation requirements and to advance and spread value-based payment programs in the state. Since 2017, participating Oregon payers have met monthly to identify opportunities for alignment, collaboration, and shared learning. They seek to identify and share payer and clinic best practices to achieve program care delivery and payment model goals.
Recognizing that primary care practices need sufficient data on quality, utilization, and cost to meet care delivery requirements, conduct quality improvement activities, and reduce costs, the payers sought to create reports that synthesize multiple payers’ data rather than present slices of data from each payer.
The report notes that during CPC Classic, Oregon had explored a shared data aggregation solution but, for a variety of reasons, it didn’t come to fruition. Under CPC+, they tried again, and in 2018, the majority of participating payers committed to aggregating claims data with Comagine Health to help payers and practices learn from the CPC+ experience.
They wanted Oregon-specific data to help stakeholders across the state understand how the model impacted primary care and the potential for spread beyond participating payers and providers. Comagine Health worked with Oregon’s largest health insurers plus the Oregon Health Authority and CMS to develop a comprehensive claims database — the Oregon Data Collaborative — which includes claims from 2015 to present, representing data for over 3 million covered Oregonian lives.
Aggregated data opened the door to examining whether and how the CPC payment models made a difference for participating practices on quality, cost, utilization, and outcomes across payers, the report said. The Oregon CPC+ Payer Group, in collaboration with Comagine Health, launched Data Bytes, a series of brief, infographic-heavy publications highlighting key analytic findings to share progress across participants following a multiyear collaborative process.
Among the findings in these Data Bytes are that practices participating in both CPC Classic and CPC+ had lower per member per month adjusted claims-based costs of adult emergency services, inpatient services, and outpatient facility costs among commercially insured patients Differences were statistically significant across all three service areas. Participating practices also had lower adult emergency department (ED) utilization and fewer avoidable ED visits than comparison practices. Significance varied by payer type.
In their analysis, the authors — Diana Bianco, Chris Demars, Lisa Miller and Emilie Sites — wrote that “While we cannot claim causation, we found that participation in CPC Classic and CPC+ is associated with positive outcomes in cost, quality, and utilization compared to nonparticipating clinics. Combining all payer types frequently resulted in statistically significant differences when an individual payer type’s results may not have been statistically significant or sometimes showed better performance in nonparticipating practices.”
During the last 18 months of CPC+, the Oregon Payer Group has committed to continue convening regularly, with a focus on gathering, analyzing, and disseminating information that demonstrates the benefits of value-based payments via the CPC+ model. In addition, the authors say, CMS has expressed interest in funding additional Data Bytes and will make its decision to do so over the next year.
