The Lewin Group to Play Key Role in Major Primary Care Transformation Initiative

The Lewin Group will play a key role in the Centers for Medicare & Medicaid Services’ largest-ever initiative to transform and improve the delivery of and payment for primary care in America.

Known as the Comprehensive Primary Care Plus (CPC+) model, the initiative aims to enable primary care physicians and practices to care for their patients in a way they think will deliver the best outcomes, and to pay clinicians for achieving results and improving care. Primary care practices can receive payments by demonstrating improved care through quality and utilization metrics.

For CPC+ “Round 1,” CMS has selected The Lewin Group and Lewin’s 10 regional partners to establish and manage 14 Regional Learning Networks (RLNs) to support nearly 3,000 practices in the CPC+ model. These practices comprise more than 13,000 primary care clinicians — including doctors, nurse practitioners and physician assistants — serving 1.75 million Medicare beneficiaries. As part of the CPC+ multi-payer approach, CMS will also work with state Medicaid agencies and 54 commercial payers across the 14 regions.

 “Strengthening primary care is critical to promoting patient health and reducing overall health care costs in the U.S.,” said Lisa Chimento, CEO of the Lewin Group. “We look forward to the opportunity of engaging with our partners and, together, working with primary care practices to provide them with the tools and capabilities they need to deliver high-quality, patient-centered and more coordinated care.”

In 2018, CMS plans to implement CPC+ in up to 24 regions across the country, and accommodate up to 5,500 practices encompassing more than 20,000 physicians.

CMS selected regions for Round 1 based on payer alignment and market density to ensure that CPC+ practices have sufficient payer support to make fundamental changes in their primary care delivery. Lewin will manage RLNs in the following “CPC+ Round 1” regions: Arkansas (statewide); Colorado (statewide); Hawaii (statewide); Kansas and Missouri (Greater Kansas City Region); Michigan (statewide); Montana (statewide); New Jersey (statewide); New York (North Hudson–Capital Region); Ohio (statewide and Northern Kentucky Region); Oklahoma (statewide); Oregon (statewide); Pennsylvania (Greater Philadelphia region); Rhode Island (statewide); and Tennessee (statewide).

Lewin will coordinate with its partners and additional CMS contractors to help physician practices, payers and other key stakeholders transform primary care delivery and payment to deliver better care, improve the health of people and encourage smarter health care spending.

A focus on patient benefits

The overall goals established by CMS for the CPC+ model — in which Lewin will play a key role — will benefit patients by helping primary care doctors and practices:

• Support patients with serious or chronic diseases to achieve their health goals
• Give patients 24-hour access to care and health information
• Deliver preventive care
• Engage patients and their families in their own care
• Work together with hospitals and other clinicians, including specialists, to provide better coordinated care

Under the CPC+ program, primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions and meet the criteria above, but practices in Track 2 will also provide more comprehensive services for patients with complex medical and behavioral health needs. This could include systematic assessments of their psychosocial needs and an inventory of resources and support to meet those needs.

To promote “high quality” and “high value” care, practices in both tracks will receive up-front incentive payments that they will either keep or repay based on their performance on quality and utilization metrics. The payments under the model encourage doctors to focus on health outcomes rather than the volume of tests or visits.

Lewin Group’s “Learning Communities” and one-on-one coaching

Specifically, Lewin will provide support through two primary vehicles:

1. Build strong and effective “learning communities” across the 14 RLNs that will provide opportunities to share best practices and lessons learned, primarily though:
   • Quarterly in-person and virtual meetings
   • By posting materials and hosting online chats on the CMS website
   • Providing written tools and materials

Visibility and communication across tracks within the Regional Learning Communities will encourage practices at every stage in the transformation process to further develop the capabilities they need to deliver comprehensive and advanced primary care.

1. Provide small-group and one-on-one practice coaching (virtually and in person) to address barriers, and eventually achieve success, to support struggling practices.

Lewin and its partners will use its expertise and breadth of skills for this project, including the fact that its consulting staff has been designing, implementing and managing numerous large-scale collaborative networks for CMS, has broad experience in managing complex projects, has as a strong background and legacy in data-driven decision making and has long assisted organizations in areas such as innovation and continuous improvement.

Lewin’s expertise will be augmented by its 10 regional partners, which will also provide a meaningful and knowledgeable local presence in all 14 regions, and nationally recognized subject matter experts in areas such as health information technology and social determinants of health.