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What CPC+ tells us about IT's role in care transformation: Don't overlook the basics

October 22, 2019

    Earlier this year, Mathematica Policy Research, a third-party firm hired by CMS to evaluate the Comprehensive Primary Care Plus (CPC+) program, released its first annual program report. CPC+, introduced by CMS in 2016, is a medical home payment model designed to improve primary care delivery.

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    In June, we offered four takeaways from the report and shared implications for population health leaders. But upon further review, we were struck by the fact that program success hinged on the effectiveness (or lack thereof) of providers' IT systems. Given CMS' expressed interest in continuing to roll out primary care focused payment models, we wanted to share our lessons for IT leaders.

    IT capabilities were a make or break factor in CPC+

    Across the board, providers' experiences with IT vendors for CPC+ were mixed—some reported that their vendor partners had developed robust functionalities related to patient empanelment, risk stratification, and quality reporting, while others reported having to resort to manual processes to track care gaps.

    Overall, practices with greater access to IT functionality performed better in CPC+, as expected. Beyond EHR functionality, the report underscored the importance of interoperability to providers' success in CPC+. Specifically, two findings stood out to us:

    • Practices with limited cross setting data exchange capabilities struggled to communicate with providers outside their own organization; and

    • System-owned practices faced fewer struggles than independent practices, in part because of their access to data analytics capabilities; some independent practices lacked resources to update their EHRs and had to resort to manual processes to track gaps in care.

    These findings emphasize that as a whole, providers still struggle to implement interoperable technology in a way that improves care delivery, especially among smaller and independent practices.

    Our take: Focus on the fundamentals

    There's a lot of excitement about digital disruption—for example, we have members asking everything from, "How can we use analytics to improve our operational efficiency?" to "How will artificial intelligence change the way we deliver care?"  

    But this report reminds us that, for many providers, there's a need to focus on the basics. Providers still have significant opportunity to improve data collection and analytics to support information sharing across sites and provide clinicians with more actionable data at the point of care. IT is the foundation of population health and is a driver of success under risk-based contracts, but providers will not be able to move the dial until data can be shared broadly and in a way that incites meaningful action. IT leaders must prioritize the basics to improve patient care, and not lose sight of that as we look to the promise of new technologies.

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