Participation in a Medicare advanced primary care model and the delivery of high-value services |
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| Authors: | Fang He PhD Angela Gasdaska BS Lindsay White PhD Yan Tang PhD Chris Beadles PhD MD |
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| Affiliation: | 1. RTI International, Research Triangle Park, North Carolina, USA;2. Institute for Advanced Analytics, North Carolina State University, Raleigh, North Carolina, USA;3. Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA |
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| Abstract: | Objective To evaluate whether primary care providers' participation in the Comprehensive Primary Care Plus Initiative (CPC+) was associated with changes in their delivery of high-value services. Data Sources Medicare Physician & Other Practitioners public use files from 2013 to 2019, 2017 to 2019 Medicare Part B claims for a 5% random sample of Medicare Fee-for-Service (FFS) beneficiaries, the Area Health Resources File, the National Plan & Provider Enumeration System files, and public use datasets from the Centers for Medicare & Medicaid Services Physician Compare. Study Design We used a difference-in-difference approach with a propensity score-matched comparison group to estimate the association of CPC+ participation with the delivery of annual wellness visits (AWVs), advance care planning (ACP), flu shots, counseling to prevent tobacco use, and depression screening. These services are prominent examples of high-value services, providing benefits to patients at a reasonable cost. We examined both the likelihood of delivering these services within a year and the count of services delivered per 1000 Medicare FFS beneficiaries per year. Data Collection/Extraction Methods Secondary data are linked at the provider level. Principal Findings We find that CPC+ participation was associated with increases in the likelihood of delivering AWVs (13.03 percentage points by CPC+'s third year, p < 0.001) and the number of AWVs per 1000 Medicare FFS beneficiaries (44 more AWVs by CPC+'s third year, p < 0.001). We also find that CPC+ participation was associated with more flu shots per 1000 beneficiaries (52 more shots by CPC+'s third year, p < 0.001) but not with the likelihood of delivering flu shots. We did not find consistent evidence for the association between CPC+ participation and ACP services, counseling to prevent tobacco use, or depression screening. Conclusions CPC+ participation was associated with increases in the delivery of AWVs and flu shots, but not other high-value services. |
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| Keywords: | Medicare access/demand/utilization of services health promotion/prevention/screening incentives in health care payment systems primary care program evaluation |
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