A study in the Journal of General Internal Medicine by researchers at UC Berkeley School of Public Health and UCSF found that the practices participating in the Comprehensive Primary Care Plus (CPC+) program had lower shares of Black and Latino patients than those not participating.
CPC+ was a multipayer payment reform model designed to improve the quality of care and reduce medical costs for adult patients with chronic conditions, particularly those who are Medicare beneficiaries. It provides primary care practices with up-front and improved payment along with technical assistance.
CMS launched CPC+ in 2017 in 14 regions and added four more regions in 2018—along with 79 public and private payers and 68 health IT vendors. CPC+ ran through December 2021.
The researchers’ analysis found that non-CPC+ practices had higher proportions of Black (12.1 percent vs. 7.1 percent, p < 0.001), Latino (3.9 percent vs. 3.1 percent, p < 0.001), and high-poverty (23.1 percent vs. 16.6 percent) beneficiaries than CPC+ practices.
“We found that the practices that are participating in the CPC+ program are practices that have low shares of Black and Latino beneficiaries,” said Karl Rubio, a senior data analyst with the Center for Healthcare Organization and Innovation Research, and lead author of the study, in a story on the UC-Berkeley Public Health website. “It’s not intentional, but the program is missing the target.”
The authors write that past research, along with their own findings, suggest that primary care practices with high concentrations of Black and Latino patients tend to be smaller than those that cater to white patients, have limited EHR capacities and have had less participation in programs to transform their practices—all prerequisites for participation.
“If you are not invited to have a seat at the table because you don’t have certain capabilities as a practice, then you and your patients are being left out,” said Taressa K. Fraze, Ph.D., assistant professor of medicine at UCSF and a coauthor of the study, in a statement.
“CPC+ says, ‘To do this, we want you to be a little bigger, because you’ll have more resources, and we want you to be in this century in terms of technology.’ That seems totally reasonable when you put it like that. They want to set the practices up for success,” she said. “But the result is that the very practices and patients who could benefit the most from a program like CPC+, because they provide financial support, are left out.”
The authors note that the CPC+ program has led to improvements in primary care delivery and reductions in emergency room visits. They also write that Medicare patients who went to CPC+ practices reported better primary care experiences than those who visited non-participating practices.
As the Biden administration considers other proposals to promote equity and reduce barriers from structural racism in medical care, the authors say, “special attention should be given to the racial and ethnic diversity of beneficiaries of enrolled practices to ensure that federally sponsored practice transformation resources can advance racial equity, while improving overall quality and managing total spending.”
CMS recognizes that this is a key challenge. Speaking last year at the University of Michigan’s Center for Value-Based Insurance Design, Dora Hughes, M.D., M.P.H., chief medical officer at the CMS Innovation Center, said a key focus is the recruitment of safety net providers, including Federally Qualified Health Centers, rural health clinics, and behavioral health clinics into alternative payment models. “We're focused on that, in part, because we need to increase the number of beneficiaries from underserved populations who are participating in our models,” she said.
