The Comprehensive Primary Care Plus Model and Health Care Spending, Service Use, and Quality.

Importance: Implemented in 18 regions, Comprehensive Primary Care Plus (CPC+) was the largest US primary care delivery model ever tested. Understanding its association with health outcomes is critical in designing future transformation models.

Objective: To test whether CPC+ was associated with lower health care spending and utilization and improved quality of care.

Features of health care interventions associated with reduced services and spending.

Objectives: This study examines 14 independent and diverse health care interventions funded under the second round of Health Care Innovation Awards by CMS to determine if any organizational, model, or implementation features were strongly associated with the programs' estimated impacts on total expenditures, hospitalizations, or emergency department visits.

Study Design: We estimated program impacts using awardee-specific difference-in-differences models based on Medicare and Medicaid enrollment and claims data for treatment and matched comparison groups from 2012 to 2018.

Methods: We used 2 analytic approaches to identify program features associated with favorable impacts.

Long-Term Effects of the Comprehensive Primary Care Model on Health Care Spending and Utilization.

Background: The Centers for Medicare & Medicaid Services launched the 4-year Comprehensive Primary Care Initiative (CPC Classic) in 2012 and its 5-year successor, CPC Plus (CPC+), in 2017 to test whether improving primary care delivery in five areas-and providing practices with financial and technical support-reduced spending and improved quality. This is the first study to examine long-term effects of a primary care practice transformation model.

Objective: To test whether long-term primary care transformation-the 4-year CPC Classic and the first 2 years of its successor, CPC+-reduced hospitalizations, emergency department (ED) visits, and spending over 6 years.

Participation in the Comprehensive Primary Care Plus Initiative.

Purpose: Comprehensive Primary Care Plus (CPC+) is the largest test of primary care payment and delivery reform. This program aims to strengthen primary care via enhanced and alternative payment, data feedback, learning, and health information technology support for practice transformation for more than 3,000 practices. We analyzed participation rates and how CPC+ practices differ from other primary care practices in CPC+ regions.

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians.

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions.

Patient experience midway through a large primary care practice transformation initiative.

Objectives: To determine how the multipayer Comprehensive Primary Care (CPC) initiative that transforms primary care delivery affects the patient experience of Medicare fee-for-service beneficiaries. The study examines how experience changed between the first and second years of CPC, how ratings of CPC practices have changed relative to ratings of comparison practices, and areas in which practices still have opportunities to improve patient experience.

Study Design: Prospective study using 2 serial cross-sectional samples of more than 25,000 Medicare fee-for-service beneficiaries attributed to 496 CPC practices and nearly 9000 beneficiaries attributed to 792 comparison practices.

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.

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.

Staffing patterns of primary care practices in the comprehensive primary care initiative.

Purpose: Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative.

Methods: We undertook a descriptive analysis of CPC initiative practices' baseline staffing using data from initial applications and a practice survey.

Examining effectiveness of medical interpreters in emergency departments for Spanish-speaking patients with limited English proficiency: results of a randomized controlled trial.

Study Objectives: This study examines whether availability of in-person professional interpreter services during emergency department (ED) visits affects satisfaction of limited English proficient patients and their health providers, using a randomized controlled trial.

Methods: We randomized time blocks during which in-person professional interpreters were available to Spanish-speaking patients in the EDs of 2 central New Jersey hospitals. We assessed the intervention's effects on patient and provider satisfaction through a multilevel regression model that accounted for the nesting of patients within time blocks and controlled for the patient's age and sex, hospital, and when the visit occurred (weekday or weekend).

Costs to Medicare of the Informatics for Diabetes Education and Telemedicine (IDEATel) home telemedicine demonstration: findings from an independent evaluation.

Objective: To estimate the impacts on Medicare costs of providing a particular type of home telemedicine to eligible Medicare beneficiaries with type 2 diabetes.

Research Design And Methods: Two cohorts of beneficiaries (n = 1,665 and 504, respectively) living in two medically underserved areas of New York between 2000 and 2007 were randomized to intensive nurse case management via televisits or usual care. Medicare service use and costs covering a 6-year follow-up period were drawn from claims data.

How caregivers and workers fared in Cash and Counseling.

Objectives: To assess the effects of Cash and Counseling on Medicaid beneficiaries' primary informal caregivers and describe the experiences of their directly hired workers.

Study Setting: Beneficiaries in Arkansas, Florida, and New Jersey voluntarily enrolled in the demonstration and were randomly assigned to direct their own Medicaid supportive services as Cash and Counseling consumers (the treatment group) or to rely on Medicaid services as usual (the control group). Beneficiaries identified their primary informal caregiver during a baseline interview and their primary paid worker during a 9-month follow-up interview.

How does Cash and Counseling affect costs?

Objective: To test the effect of a consumer-directed model (Cash and Counseling) of Medicaid personal care services (PCS) or home- and community-based waiver services (HCBS) on the cost of Medicaid services.

Data Sources/study Setting: Medicaid claims data were collected for all enrollees in the Cash and Counseling demonstration. Demonstration enrollees included those eligible for PCS (in Arkansas), those assessed to receive such services (in New Jersey), and recipients of Medicaid HCBS (in Florida).

Effects of Cash and Counseling on personal care and well-being.

Objective: To examine how a new model of consumer-directed care changes the way that consumers with disabilities meet their personal care needs and, in turn, affects their well-being.

Study Setting: Eligible Medicaid beneficiaries in Arkansas, Florida, and New Jersey volunteered to participate in the demonstration and were randomly assigned to receive an allowance and direct their own Medicaid supportive services as Cash and Counseling consumers (the treatment group) or to rely on Medicaid services as usual (the control group). The demonstration included elderly and non-elderly adults in all three states and children in Florida.

The research design and methodological issues for the Cash and Counseling Evaluation.

Objective: To provide an overview of the design, research questions, data sources, and methods used to evaluate the Cash and Counseling Demonstration and resolution of analytic concerns that arose. The methodology was designed to provide statistically rigorous estimates while presenting the findings in a manner easily accessible to a broad, non-technical audience.

Study Setting: Eligible Medicaid beneficiaries in Arkansas, Florida, and New Jersey who volunteered to participate in the demonstration were randomly assigned to receive an allowance and direct their own Medicaid supportive services as Cash and Counseling consumers (the treatment group) or to rely on Medicaid services as usual (the control group).

Reducing nursing home use through consumer-directed personal care services.

Context: Personal care services (PCS) are intended to enable beneficiaries with physical or cognitive impairments to live safely at home rather than in nursing facilities. The quality and flexibility of these services, typically provided by home care agencies, may not be sufficient to allow some beneficiaries to continue living at home.

Objective: We sought to test whether consumer direction of PCS under Arkansas's Cash and Counseling demonstration reduces nursing facility use and expenditures, compared with traditional Medicaid PCS, and how it affects total Medicaid cost.

How do hired workers fare under consumer-directed personal care?

Purpose: This study describes the experiences of workers hired under consumer direction.

Design And Methods: Medicaid beneficiaries who volunteered for the Cash and Counseling demonstration were randomly assigned to the treatment group, which could participate in the consumer-directed program, or the control group, which was referred to agency care. Paid workers for both groups were surveyed about 10 months after demonstration enrollment.

The effects of cash and counseling on personal care services and Medicaid costs in Arkansas.

The Cash and Counseling Demonstration gives Medicaid beneficiaries who are eligible for personal care services a consumer-directed allowance in lieu of traditional agency services. Using survey and Medicaid claims data on 2,008 adult applicants randomly assigned to treatment or control groups, we find the program increased the receipt of paid care but reduced unpaid care. The treatment group had higher Medicaid personal care expenditures than controls did, because many controls received no paid help, and recipients obtained only two-thirds of entitled services.