The CDPHP® Enhanced Primary Care (EPC) initiative is an innovative patient-centered medical home (PCMH) model that offers increased value for members and financial rewards for physicians.
In 2008, after noting a decline in the number of graduating medical students choosing to become primary care physicians, CDPHP set out on a mission to save the field of primary care medicine while improving the value and quality of care for members. The result was the creation of the CDPHP Enhanced Primary Care (EPC) initiative, a patient-centered medical home (PCMH) model that rewards doctors for spending more time with their sickest patients. A guiding principal of the EPC model is that each patient has an ongoing relationship with a primary care practice (PCP) that delivers continuous, comprehensive, and coordinated care.
A cornerstone of the EPC program is a unique payment model that rewards PCPs for their efforts to keep patients healthy. The program departs from the traditional fee-for-service model, which incentivizes doctors to provide more, not better care. Instead, EPC moves doctors to a global payment model, with the addition of a significant bonus opportunity. These two payment structures combine to give physicians the opportunity to increase their earning potential by an average of 40 percent.
In 2014, CDPHP realized a cost savings of $20.7 million directly related to the EPC program. Approximately 60 percent of this savings 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. 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. 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. 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. The findings prove that EPC sites are not only performing at a higher level that non-EPC sites, but they are improving at a faster rate.