Abstract
Little is known about the types of primary care practices that have chosen to participate in the Comprehensive Primary Care Plus (CPC+) program or about how participation could affect disparities. To describe practices that joined the CPC+ model and compare hospital service areas with and without CPC+ practices. This comparative cross-sectional study identified 2647 CPC+ practices in round 1 (from January 1, 2017; round 1 is ongoing through 2021). Using IMS Health Care Organization Services data, ownership and characteristics of health systems and practices were extracted. Practices participating in the CPC+ program were compared with practices with similar proportions of primary care physicians (>85%) within the 14 regions designated as eligible to participate by the Centers for Medicare & Medicaid Services. Within eligible regions, hospital service areas with (n = 434) and without (n = 322) 1 or more CPC+ practice were compared. Characteristics compared included area-level population demographics (from the US Census Bureau), health system characteristics (from the IMS Health Care Organization Services), and use of health services by Medicare fee-for-service enrollees (Dartmouth Atlas). Area-level characteristics of all eligible CPC+ regions, areas without a CPC+ practice, and areas with 1 or more CPC+ practices. Of 756 eligible service areas, 322 had no CPC+ practices and 434 had at least 1 CPC+ practice. Of 2647 CPC+ practices, 579 (21.9%) had 1 physician and 1791 (67.7%) had 2 to 10 physicians. In areas without CPC+ practices, the population had a lower median income ($43 197 [interquartile range, $42 170-$44 224] vs $57 206 [interquartile range, $55 470-$58 941]), higher mean share of households living in poverty (17.8% [95% CI, 17.2%-18.4%] vs 14.4% [95% CI, 13.9%-15.0%]), higher mean educational attainment of high school or less (52.7% [95% CI, 51.7%-53.6%] vs 43.1% [95% CI, 42.1%-44.2%]), higher mean proportion of disabled residents (17.7% [95% CI, 17.3%-18.2%] vs 14.2% [13.8%-14.6%]), higher mean participation in Medicare (21.9% [95% CI, 21.3%-22.4%] vs 18.8% [95% CI, 18.3%-19.1%]) and Medicaid (22.2% [95% CI, 21.5%-22.9%]) vs 18.5% [95% CI, 17.8%-19.2%]), and higher mean proportion of uninsured residents (12.4% [95% CI, 11.9%-12.9%] vs 10.3% [95% CI, 9.9%-10.7%]) (P < .001 for all) compared with areas that had a CPC+ practice. According to this study, although a diverse set of practices joined the CPC+ program, practices in areas characterized by patient populations with greater advantage were more likely to join, which may affect access to advanced primary care medical home models such as CPC+, by vulnerable populations.
Highlights
According to this study, a diverse set of practices joined the CPC+ program, practices in areas characterized by patient populations with greater advantage were more likely to join, which may affect access to advanced primary care medical home models such as CPC+, by vulnerable populations
With the aim of improving the quality, accessibility, and efficiency of care, the Comprehensive Primary Care Plus (CPC+) model is the largest test by the Centers for Medicare & Medicaid Services (CMS) of an advanced primary care medical home model.[1]
One thousand five hundred forty-nine CPC+ practices (58.5%) were owned by a health care system compared with 2127 comparison practices (17.7%)
Summary
With the aim of improving the quality, accessibility, and efficiency of care, the Comprehensive Primary Care Plus (CPC+) model is the largest test by the Centers for Medicare & Medicaid Services (CMS) of an advanced primary care medical home model.[1] The CPC+ is a voluntary multipayer model that combines primary care redesign with efforts to restructure payment through prospective care management payments and performance-based incentives for care improvement Such models have the potential to enhance care for the nation’s most vulnerable patients, evidence suggests that care delivery reform models may widen gaps across communities, because physicians in areas with low resources may choose not to participate.[2,3,4,5,6] Little is known about the types of practices participating in medical home models or whether participation may affect disparities. We describe the inaugural CPC+ practices and compare hospital service areas with and without a CPC+ practice
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