CMS Demonstration to Test Efficacy of Advanced Primary Care Model

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Program will fund the transformation of 500 health centers into advanced primary care practices.

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The Centers for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA) have announced a demonstration project intended to evaluate the adoption of Advanced Primary Care (APC) practices by community health centers.

The APC model relies on the use of physician- or nurse practitioner-led collaborative teams of health professionals to provide patients with comprehensive and personalized primary care.  According to CMS, medical care under APC requires a “shift from an acute care complaint-driven primary care paradigm that fragments health care delivery to one that is geared to maintain the patient’s overall health and anticipates when additional services or coordination needs to occur.”

The three-year APC demonstration started on November 1, 2011 and will include 500 Federally-Qualified Health Centers (FQHCs) that are expected to adopt APC practices.  The health centers that participate in the demonstration will receive a small monthly fee for each of their eligible Medicare patients in addition to usual Medicare reimbursements. CMS and HRSA will offer technical assistance and training to the health centers free of charge.

The health centers must apply for and receive approval from the National Committee for Quality Assurance before October 31, 2014, the end of the demonstration. This application requires meeting a number of standards, including tracking all the medical care their patients receive, anticipating obstacles that may prevent patients from complying with treatment, and advising patients on resources to manage chronic conditions. The goal is to create a comprehensive treatment plan, including preventative measures, tailored to each patient.

Health centers will submit progress reports to CMS every 6 months, and may be subject to random site audits.  CMS will also perform an independent evaluation of the program’s effects on patient care and medical costs.