The Affordable Care Act gave rise to new initiatives within the Centers for Medicare and Medicaid Services. One of them, the Comprehensive Primary Care Initiative (CPCI) -- a joint pilot project involving private payers and CMS -- experiments with the concept of creating patient medical homes managed by primary care providers.
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Physicians in the five to seven regions where CMS is piloting CPCI will need some IT infrastructure to participate, according to experts presenting at a recent webinar hosted by the American Academy of Family Physicians (AAFP). In its policies the physician's group supports universal health care and encourages its members to be "well-informed about the continuously evolving health care delivery system options available to them and their patient."
The Comprehensive Primary Care Initiative will run four years. Two of the regions in the pilot must have 50% of their physician practices in rural counties. Up to 75 physicians in each pilot region can participate. They will receive per-patient compensation for care management, as well as additional compensation if there are savings to share.
The IT pieces needed to partake in Comprehensive Primary Care Initiative needs
The program requires much interaction between primary care physician offices and the outside health care world. Technology makes those tasks quicker and more straightforward, said Bruce Bagley, M.D., AAFP medical director of quality improvement, who presented along with Terry McGeeney, M.D., president and CEO of TransforMED, AAFP's clinical and practice management consultancy.
"IT is an enabler," Bagley said. "It's not the solution in itself, but it enables us to do all the things we're talking about."
Participating physicians will need an electronic health record (EHR) system for several basic care-management tasks:
- Getting a patient's data in a registry.
- Writing care plans (or importing them from a hospital EHR if the primary care physician is taking over after a hospital discharge).
- Home monitoring.
- Issuing between-visit contacts and reminders.
- Sharing education materials with patient and family members about their health conditions.
The Comprehensive Primary Care Initiative will likely also involve at least some rudimentary data analytics in order to identify which patients are at risk, or in need of, the most comprehensive care coordination.
The care coordination model will require physician connectivity to local hospitals and other care providers to conduct tasks such transitioning patients from hospital to home or long-term care. Other tasks requiring connectivity and software tools outside the doctor's office include medication reconciliation, shaping care plans and pulling together patient documentation from other offices. After that comes tracking lab results and specialist consultations, as well as following up on their reports and recommendations with the patients.
Bagley pointed out that CMS expects care coordination services to be available to patients in CPCI practices 24/7. An off-hours voicemail message stating the office is closed and referring patients to the emergency room won't cut it. CMS not only requires live help for patients; the care coordinator taking off-hours calls must have access to the EHR system.
AAFP: Doctors should invest in IT for care coordination model
There are 661,000 physicians and surgeons in the United States, according to the Bureau of Labor Statistics. The AAFP boasts almost 100,000 members, with students and international members comprising about a sixth of that membership. At most, the Comprehensive Primary Care Initiative will only enroll 525 physicians.
The Comprehensive Primary Care Initiative selection process will be competitive, so the most-wired physicians will be the best candidates for participation.
That's a drop in the bucket. Yet Bagley encouraged AAFP members to go ahead and build the IT infrastructure required by the CPCI regardless of whether they, or their market, are chosen for the pilot, for two reasons.
- The Comprehensive Primary Care Initiative selection process will be competitive, so the most-wired physicians will be the best candidates for participation.
- Care coordination by family physicians will be part of future U.S. health care delivery, whether or not this particular CMS pilot succeeds and becomes the new, permanent replacement for the current fee-for-service model. If it doesn't, Bagley believes private and public insurers will continue to experiment with similar payment models that will involve similar IT support. Physicians who invest now will be ahead of the curve, their practices better positioned to capitalize on new payment models like the CPCI.
Bagley said similar programs are cropping up all over the country. The faster physicians set up IT support, the faster they will get plugged into new care-payment models offered by payers, since most of them require the same tools.
"Everybody's preaching from the same bible, so to speak," McGeeney added, referring to the resemblances between the Comprehensive Primary Care Initiative and other programs he's seen for family physicians. These include the 15 states that have Medicaid care coordination pilots and care coordination programs from Aetna Inc. and several Blue Cross/Blue Shield member companies. "It's critical that [physicians] think about this in terms of the bigger picture."