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Medicare, Insurers Offer Financial Incentives for Better Primary Care Management

By CQ Staff

June 6, 2012 -- Federal Medicare officials are teaming up with other government and private insurers to provide financial incentives to primary care practices to better manage patient care.

Under the program announced last week, 45 commercial, federal, and state insurers in seven markets will collaborate with the Centers for Medicare and Medicaid Services (CMS) in a four-year initiative administered by CMS' innovation center. About 75 primary care practices from each market will be selected to participate, and the application period is open until July 20.

Under the Comprehensive Primary Care initiative, CMS will pay participating primary care practices a care management fee averaging $20 per month per Medicare beneficiary. At the same time, the other insurance partners will offer payments to these practices to provide similar services for those payors' members. CMS officials said they don't yet know how much the total project will cost.

Insurers in Arkansas, Colorado, New Jersey, Oregon, New York's Capital District-Hudson Valley Region, Ohio's and Kentucky's Cincinnati-Dayton region, and greater Tulsa, Okla., signed agreements with CMS to participate in this initiative, CMS officials said, adding that the markets were selected based on a diverse pool of applicants from commercial health plans, state Medicaid agencies, and self-insured businesses who hoped to work alongside Medicare to support comprehensive primary care.

In order to receive the new care management fee from CMS and insurers, primary care practices must agree to provide enhanced services for their patients, including offering longer and more flexible hours, using electronic health records, delivering preventive care; coordinating care with patients' other health care providers, engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

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