The Centers for Medicare & Medicaid Services (CMS) announced this week the start of a pilot program to enhance primary care via collaboration among CMS, private health insurance carriers and 500 primary care practices in seven regions across the US. 73 of those practices are in Colorado, with 335 participating physicians, and several of the top health insurance carriers in Colorado are participating too: Anthem Blue Cross Blue Shield, Cigna, Humana, Rocky Mountain Health Plans, and United Healthcare, in addition to Colorado Medicaid, Colorado Choice Health Plans, and Colorado Access (a health plan specifically designed for underserved populations).
CMS will be paying participating providers a “care management fee” which is estimated to be about $20 per month per beneficiary, in addition to the usual fee-for-service reimbursements. The private health insurance carriers that are participating have worked out their own reimbursement schedules, but one would assume that the setup will be similar to the one that CMS has devised.
It’s exciting that Colorado was only of only seven regions selected to be part of this pilot program, and several of the primary care practices involved are right in our backyard. The program will hopefully result in healthier patients and fewer hospital stays since the focus will be on better management of chronic conditions, more efficient electronic medical records and care coordination among providers, and better access to healthcare providers via extended hours and email/phone consultations.
Grand Junction, Colorado has already been featured heavily in the news over the past few years as a model of healthcare efficiency and progress, so it’s not surprising that several practices in Grand Junction will be part of the pilot program. But there are other practices all over the state that will also be involved. Some patients won’t see many changes in terms of how their healthcare is delivered, since many of the participating offices have already been moving forward to implement various improvements such as electronic medical records and better coordination of care. But overall, it will be interesting to see how the 500 practices in this program compare with average primary care offices at the end of the four year pilot program. My guess would be that they were already pretty forward-thinking and results-oriented to begin with, since they were motivated enough to apply for – and be accepted into – the pilot program. Chances are, their care models are already something to emulate, and this program will enhance that even more.
