Richard F. Shonk, Laura L. Sessums Health Affairs Blog 12/4/2018

“Because that evaluation did not include the costs of any of the non-Medicare payers partnering in CPC, we wondered about the results the other payers were seeing. Given that the private health plans in at least one region—the Southwest Ohio/Northern Kentucky region (OH/KY), (the Greater Cincinnati/Dayton metropolitan statistical area)—were willing to continue and expand their foot print in the Comprehensive Primary Care Plus program (CPC+, the successor to CPC), were their results more positive? Additionally, if the physicians saw no improvement in their experience, why did all 75 CPC practices in that region reapply for five more years in CPC+? “

“In conversation with three of the private health plans that participated in CPC, several reasons for continued participation emerged. Consistent with the all-payer data trends for Medicare Advantage and commercial populations, the private plans saw significant decreases in cost when comparing CPC practices to non-CPC internal cohorts. Two saw reductions sufficient to cover the cost of care management fees paid to the CPC practices. One realized significant savings net of care management fees and shared a proportion of those savings with the practices. In addition, all three included other in-kind support provided to the practices in their calculations of total cost. Other reasons cited as important:

• Generally, the plans saw significant quality of care improvement. Bonus or shared savings payments were contingent on meeting quality targets.
• The plans were already committed to value-based payment models with most of their physician networks, and the CPC program fit nicely into that business strategy.
• The multipayer approach of CPC meant practices could reach the critical mass of necessary funding to support overall practice change.
• Some plans observed that funds previously spent on care management internally were more effective when diverted to practices, as patient engagement was better.
• One plan was able to demonstrate to its large self-funded employers that the investment was financially better than break even, while also delivering better quality.

“In short, private health plans confirmed that they were seeing better results in many different areas and that their investment in CPC practices was financially viable. They also noted the added bonus that their physician networks were requesting these arrangements.”

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