- Primary care medical home models, such as the CMS Comprehensive Primary Care (CPC) initiative, have a modestly positive effect on patient experience scores, highlighting the value of these programs for improving patient care, according to a study published in the American Journal of Managed Care.
CMS began the CPC initiative in October 2012 as a part of the agency’s overall mission to tie 50 percent of all Medicare payments to quality and value by 2018. Per CMS, the CPC initiative is a multi-payer collaborative “to offer population-based care management fees and shared savings opportunities to participating primary care practices to support the provision of a core set of five ‘Comprehensive’ primary care functions.”
Those five primary care functions include the following:
- Access and continuity
- Planned chronic and preventive care
- Risk-stratified care management
- Patient and caregiver engagement
- Coordination of care across the medical neighborhood
Patient-centeredness was one of the primary goals of the CPC initiative, according to the research team.
“Practices were expected to provide better access to care, engage patients in order to guide quality improvement through surveys and/or a patient and family advisory council, integrate culturally competent self-management support and shared decision-making tools into care, coordinate care across the medical neighborhood, and use a personalized plan of care for high-risk patients,” the team explained.
In an analysis of year-to-year patient experience within the CPC program, the researchers found that the program does achieve these patient-centered goals, but only by a small margin.
The researchers looked at patient experience improvements during months eight to 12 and 21 to 24 of the program, assessing year-to-year patient satisfaction changes. The team surveyed nearly 25,000 patients at 496 CPC practices and 9,000 Medicare beneficiaries at 792 non-CPC practices.
The team used six domains from the CAHPS survey to measure patient satisfaction, including the following:
- Patients’ ability to get timely appointments, care, and information
- How well providers communicate
- Providers’ knowledge of the care patients received from other providers
- If providers support patients in taking care of their own health
- If providers discuss medication decisions with patients
- Patients’ overall rating of their primary care provider
Overall, patient experience at both CPC and non-CPC practices was equal, with some areas having modest improvements in CPC practices.
A larger proportion of CPC patients gave positive reports for getting timely appointments, care, and information; providers supporting patients in self-management; and providers discussing medication decisions with patients.
The research team noted that these improvements were in the proportion of patients reporting positive experiences for these domains, and that there was no difference in the mean number of patients giving positive responses on the CAHPS surveys.
The equal, and sometimes better, patient satisfaction scores for the CPC initiative show that this program is a benefit for patient-centered primary care, the researchers pointed out. These results show that the CPC model is not a detriment to primary care and is a promising solution to drive value-based care.
“Our results allay concerns that the disruptions inherent in the early stages of primary care transformation and payment reform impair patient experience of care,” the researchers said. “The small improvements in patient experience also suggest that future efforts in primary care may be a path toward improved patient experience.”
The results may also inform future value-based care initiatives.
“These findings are a timely and important contribution, as CMS launched the new CPC Plus model, the largest investment in advanced primary care to date,” the investigators concluded. “As the US healthcare system moves from traditional FFS to new models that reward value instead of volume, maintaining and improving patient experience of care will be critically important.”