Evaluation of the Comprehensive Primary Care Initiative

NCT02320591 | Completed

• 1 other identifier: HHSM-500-T0006
• Study Type: interventional
• Target: 365,076
• Locations: 1 country
• Sites: 1

Brief Summary

This study assesses the effects of the Centers for Medicare and Medicaid Services' Comprehensive Primary Care (CPC) initiative on physician practices, practice staff, Medicare and Medicaid costs and service utilization, quality of care, and patient outcomes. CPC provides financial resources, timely feedback on key practice outcomes, and a learning network to support practice transformation to improve quality of care and lower costs.

Conditions

Medicare Expenditures, Quality of Care

Outcome Measures

Primary Outcomes (1)

• Medicare expenditures

  average Medicare expenditures per month in Medicare fee-for-service

  12 months

Secondary Outcomes (4)

• number of ER visits

  12 months

• number of hospital admissions

  12 months

• 30-day hospital readmission rate

  30-days

• hospital admission for ambulatory care sensitive condition

  12 months

Study Arms (2)

Treatment group

EXPERIMENTAL

Practices assigned to the treatment group received per member per month care management fees for each Medicare beneficiary attributed to their practice. They also received quarterly feedback reports on their patients' average Medicare expenditures and use of hospital and emergency room services. Practices also had access to regional learning faculties for technical assistance with transformation activities and to share lessons across practices.

Other: care management fee; Other: feedback reports; Other: technical assistance

Comparison group

NO INTERVENTION

Within each of the 7 regions, this group is comprised of practices that were matched to the treatment practices on a wide range of baseline characteristics of the practices (including their service utilization patterns) and their patients. Comparison practices were selected from a pool of practices including those that applied to participate but were not selected, and practices serving nearby external comparison areas.

Interventions

care management fee OTHER

for each Medicare beneficiary attributed to the practice, the practice received a monthly care management fee

Treatment group

feedback reports OTHER

Each participating practice received quarterly reports showing the practice's trend in key outcomes during the pre-intervention and intervention periods. The risk adjusted average Medicare expenditures of their patients were also shown in relation to all of the other CPC practices in their region, and to those with a similar average risk profile. Unadjusted hospitalization rates and emergency room visits were also plotted over time and compared to those of other CPC practices in the region

Treatment group

technical assistance OTHER

CPC practices could ask for technical assistance on transformation activities from a regional learning faculty (RLF). The RLF also provided seminars and other learning activities, as well as provided a forum for participating practices to share lessons they had learned.

Treatment group

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Medicare beneficiary attributed to CPC practice or to a matched comparison practice. Patients are attributed to the practice from which they received the most E\&M visits during the 2-year period examined.

You may not qualify if:

• Beneficiaries enrolled in a managed care plan.

Sponsors & Collaborators

• Mathematica Policy Research, Inc.: lead
• Centers for Medicare and Medicaid Services: collaborator

Study Sites (1)

Mathematica Policy Research

Princeton, New Jersey, 08540, United States

Location

Related Publications (2)

• Peikes DN, Swankoski K, Hoag SD, Duda N, Coopersmith J, Taylor EF, Morrisson N, Palakal M, Holland J, Day TJ, Sessums LL. The Effects of a Primary Care Transformation Initiative on Primary Care Physician Burnout and Workplace Experience. J Gen Intern Med. 2019 Jan;34(1):49-57. doi: 10.1007/s11606-018-4545-0. Epub 2018 Jul 17.

  PMID: 30019124 DERIVED

• Dale SB, Ghosh A, Peikes DN, Day TJ, Yoon FB, Taylor EF, Swankoski K, O'Malley AS, Conway PH, Rajkumar R, Press MJ, Sessums L, Brown R. Two-Year Costs and Quality in the Comprehensive Primary Care Initiative. N Engl J Med. 2016 Jun 16;374(24):2345-56. doi: 10.1056/NEJMsa1414953. Epub 2016 Apr 13.

  PMID: 27074035 DERIVED

MeSH Terms

Interventions

Health Planning Technical Assistance

Intervention Hierarchy (Ancestors)

Health Planning; Health Care Economics and Organizations

Study Officials

• deborah peikes, PhD

  Mathematica Policy Research

  PRINCIPAL INVESTIGATOR

• Timothy Day, MPP

  Centers for Medicare & Medicaid Services

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Project Director; Director of Health Services Research

Study Record Dates

• First Submitted: December 15, 2014
• First Posted: December 19, 2014
• Study Start: July 1, 2012
• Primary Completion: July 1, 2017
• Study Completion: May 1, 2018
• Last Updated: August 14, 2019

Record last verified: 2019-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)