CDPHP announced the results of a study
that show the health plan’s Enhanced Primary
Care (EPC) initiative produced $20.7 million
in savings in 2014, while improving the quality
of care for hundreds of thousands of patients.
In 2008, after noting a decline in the number
of local medical students who were choosing
to become primary care physicians, CDPHP
created the EPC program, a patient-centered
medical home model that rewards doctors for
spending more time with their sickest patients.
“EPC has given primary care doctors the
freedom to practice medicine in a way that’s
innovative, efficient, and more convenient for
their patients. This program puts patients at the
center of the health care system, and encourages
a team-based approach to care, allowing
primary care physicians to work together
with pharmacists, nurses, cases managers, and
mental health experts to better coordinate the
care of their patients,” said Dr. John D. Bennett,
president and CEO of CDPHP.
Officials said a cornerstone of the EPC
program is a unique payment model that
rewards primary care physicians (PCPs) for
their efforts to keep patients healthy. The
program departs from the traditional fee-for-service
model, which incentivizes doctors for
providing more, not better care.
Instead, EPC moves PCPs to value-based
payments with the opportunity for enhanced
bonus payments.
“We knew that in order for EPC to be
successful, we needed to get doctors off the
so-called ‘hamster wheel’ of fee-for-service.
We are now rewarding doctors for quality
over quantity, and offering significant bonus
opportunities for those physicians who are able
to meet specific performance metrics,” said Dr.
Bruce Nash, chief medical officer at CDPHP.
Now in its seventh year, the EPC program
includes 193 physician practices, 836 network
clinicians, and nearly 250,000 CDPHP
members.
Dr. Holly Cleney, a primary care doctor at Latham Medical Group, part of Community
Care Physicians PC, said EPC has allowed her
and her colleagues to innovate in ways she
never imagined.
“This unique payment model enhances,
rather than discourages, our ability to be real
primary care doctors, which means taking
care of our patients both inside and outside
the office. We’re communicating electronically
with our patients, offering group visits, and
providing educational sessions on smoking
cessation and diabetes management. We even
have a patient advisory council that provides
feedback on how we’re doing,” she said.
Officials said in 2014, CDPHP realized a
cost-savings of $20.7 million directly related
to the EPC program. Approximately 60
percent was experienced by members within
the commercial market, while approximately
20 percent was experienced by the sickest
10 percent of members in the Medicaid and
Medicare markets.
EPC providers received an estimated $12.8
million more in reimbursements and enhanced
bonuses than if they had not participated in
the program, according to the company. In
exchange for these increased payments, CDPHP
encouraged physicians to change the way they
deliver care to patients.
This often involves convenient office hours,
communicating with patients via email, the
use of patient portals and electronic medical
records, and an overall emphasis on preventive
care.
In addition to cost savings, the program has
also produced impressive quality results, said
officials. From 2010 to 2014, EPC sites showed
significant improvements on a series of quality
measures that included breast and colorectal
cancer screenings, childhood immunizations,
childhood well visits, and more.
CDCHP said throughout the analysis, quality
scores for EPC sites rose from 71 to 77 percent.
During the same time period, quality scores for
non-EPC sites rose from 65 to 68 percent.