Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

CMS: Population Health Management Reduces Admissions, ER Use

By Jennifer Bresnick

- Two population health management initiatives that focus on increasing the use of primary care providers have reaped significant results for patients, says CMS Deputy Administrator and Chief Medical Officer Dr. Patrick Conway.  The Comprehensive Primary Care (CPC) and Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration have reduced hospital admissions by 2 percent, cut emergency department use by 3 percent, and saved approximately $4.2 million, according to a report and blog post detailing the results.

The Centers for Medicare and Medicaid Services

The CPC initiative, launched in 2012, asked public and private payers in seven regions to utilize data-driven population health management techniques to plan and provide primary care services based on risk stratification, patient engagement, and improved coordination of care.  Nearly five hundred practices participated during the program’s first year, covering 345,000 Medicare patients and more than 2 million private insurance beneficiaries.

Reduced hospital admissions and emergency department visits by the highest risk patients provided the majority of the $227,000 in care management fees paid to the average practice.  The program generated a total of $141.3 million in payments from CMS and private payers.  Participating providers also received data feedback from payers detailing their care quality as well as CMS education and support to encourage the necessary organizational transformation.  The process revealed that healthcare organizations with robust EHR and health information exchange capabilities, as well as those previously participating in the EHR Incentive Programs, were more likely to successfully adapt to the requirements of the CPC initiative.

Meanwhile, the state-administered MAPCP Demonstration created a collaboration between Medicare, Medicaid, and private payers in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island, and Vermont.  “Under this demonstration, participating practices and other auxiliary supports (e.g., community health teams) receive monthly care management fees from the participating payers and additional support (e.g., data feedback, learning collaboratives, practice coaching),” Conway explains.

Four hundred thousand Medicare beneficiaries in 700 practices participated in MAPCP, which generated $4.2 million in savings.  The rate of growth in healthcare expenditure under the Medicare fee-for-service model was slowed in Vermont and Michigan, although the impact of the program on hospital admissions and readmissions, as well as ED use, were less clear than in the CPC program.

The population health management effort did prove that Medicare could integrate “seamlessly” with state organizations to coordinate care, Conway says.  Providers supported by the MAPCP payments were able to leverage the expertise of care managers and coordinators, improve patient flow, make better use of EHRs and other health IT, and foster a collaborative environment for staff members.

Participating providers became more aware of the need for comprehensive primary care, but the program also highlighted the need for improved data collection, reporting, and exchange as the focus on care coordination tested the limits of existing infrastructure.

“These first-year results illustrate the potential for steady improvements in the participating practices’ advanced primary care capabilities,” Conway added. “CMS anticipates continued improvements as the participating practices deepen and refine their methods of delivering advanced primary care so that patients can continue to receive improved quality and coordination of care.”

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