title: Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.
abstract: BACKGROUND
  The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support.
  
  
  METHODS
  We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices.
  
  
  RESULTS
  During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI], -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (P<0.001) and changes in two of the six domains of patient experience--discussion of decisions regarding medication with patients and the provision of support for patients taking care of their own health--both of which showed a small improvement in initiative practices relative to comparison practices (P=0.006 and P<0.001, respectively).
  
  
  CONCLUSIONS
  Midway through this 4-year intervention, practices participating in the initiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after accounting for care-management fees, nor have they shown an appreciable improvement in the quality of care or patient experience. (Funded by the Department of Health and Human Services, Centers for Medicare and Medicaid Services; ClinicalTrials.gov number, NCT02320591.).
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Stacy B
authors.initials: SB
authors.lastname: Dale
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Arkadipta
authors.initials: A
authors.lastname: Ghosh
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Deborah N
authors.initials: DN
authors.lastname: Peikes
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Day
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Frank B
authors.initials: FB
authors.lastname: Yoon
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Erin Fries
authors.initials: EF
authors.lastname: Taylor
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Kaylyn
authors.initials: K
authors.lastname: Swankoski
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Ann S
authors.initials: AS
authors.lastname: O'Malley
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Conway
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Rahul
authors.initials: R
authors.lastname: Rajkumar
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Press
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Laura
authors.initials: L
authors.lastname: Sessums
authors.affiliation: From Mathematica Policy Research, Chicago (S.B.D.), Princeton, NJ (A.G., D.N.P., F.B.Y., K.S., R.B.), and Washington DC (E.F.T., A.S.O.); and the Centers for Medicare and Medicaid Services, Baltimore (T.J.D., P.H.C., R.R., M.J.P., L.S.).
authors.forename: Randall
authors.initials: R
authors.lastname: Brown
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D003191:Comprehensive Health Care; D018588:Fee-for-Service Plans / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D006278:Medicare / Q000191:economics* / Q000592:standards; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care; D014481:United States