A VOLUNTARY DEMONSTRATION project launched by the US Department of Health and Human Services (DHHS) will test the theory that having primary care practices coordinate care through a patientcentered model can reduce health care costs and improve patient health. TheComprehensivePrimaryCareInitiative,announcedSeptember28,willtake place in 5 to 7 health insurance markets acrossthecountry,withabout75primary carepracticeswithlargenumbersofMedicareandMedicaidpatientsparticipating ineachmarket.The initiative,whichwill cover as many as 330 750 Medicare and Medicaid beneficiaries, is one of several projects launchedbytheDHHSaspartof thePatientProtectionandAffordableCare Act’smandatetoexplorewaystopromote coordinatedandlower-costcarewhileimproving patient health. Primarycarepractices thatparticipate intheinitiativeareexpectedtohelpMedicare and Medicaid patients with serious or chronic diseases follow personalized care plans, provide patients 24-hour access to care and health information, deliverpreventivecare,engagepatientsand their families intheirowncare,andwork together with other physicians, including specialists, to provide better coordinated care. To help defray the costs of rampingupapractice’sobligations,Medicare will pay these physician offices, on average, $20 per Medicare member per month for the first 2 years of the initiative. For years 3 and 4, the average reimbursement will drop to $15 per member permonth,butpracticeswillhavetheopportunity toshare inaportionof thetotal savings in their particular market. Akeycomponentoftheinitiativeishavingmultiple insurerswithinamarketvoluntarilyagreeingtoparticipatetoprovide enhancedsupportaboveandbeyondvisitbased fee-for-service payments, such as caremanagement feesand incentives for effective uses of resources, said Richard Baron,MD,directorof theSeamlessCare Models Group in the Centers for MedicareMthisfeeisastrategy to address it,”said Stream, a family practice physician in Spokane, Wash. Eugene Rich, MD, who studies clinicalpracticetransformationandisasenior fellowwithMathematicaPolicyResearch in Washington, DC, views the initiative favorably, saying the key is to get payers in line to reimburse for services that improvecarequality.“Oneofthechallenges any initiative has is in dealing with multiple payers, so this project will pull payers together in their markets first before gettingproviderstoparticipate,”Richsaid. “It makes it easier for primary care physicians toparticipate if allormostareoperatingbasedoncommonexpectations.” Baronsaidhehopesprimarycarepracticesofall sizesagree toparticipate in the initiative because the DHHS wants each demonstration project to reflect its own market’scaredeliverylandscape.Practices hopingtoparticipateintheinitiativemust use electronic health record systems or electronicregistries;mustbeprimarycare practicesthatprovidethefirstpointofcontact for patients and ongoing care; and must be led by a board-certified general practitioner, internist, family physician, geriatrician, or advanced practice nurse (as allowed by state law). The practices mustconsistmostlyofprimarycareprofessionals.Also,thesepracticesmusthave at least 60% of their revenues generated by payers participating in this initiative andhaveaminimumof200eligiblenoninstitutionalized Medicare beneficiaries whoareeligible for aPartAandenrolled in a Part B but not in a Part C plan, Medicare Cost Plan, Demonstrations Plan, or PACE Plan, and who do not have endstage renal disease.