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The Comprehensive Primary Care Plus (CPC+) initiative, a multipayer payment reform model, provided incentives for practices to lower spending and improve quality.

Adam Markovitz and colleagues use claims and enrollment data from two large insurers in Michigan to evaluate the effects of CPC+ on enrollee spending and quality from the period 2013–20.

They find that CPC+ was neither associated with reductions in total spending or most components of spending nor associated with improvements in overall quality performance among enrollees.

The authors indicate that a multipayer model can create coordination and integration problems from both a provider and a programmatic perspective.

They conclude that that CPC+ did not improve spending or quality for private-plan enrollees in Michigan, even before accounting for payouts to providers.

Markovitz and colleagues' policy recommendations focus on strengthening financial incentives in CPC+ by requiring that practices transition a greater portion of their payments to partial capitation.

Elsewhere in Health Affairs Forefront, Christine Aguiar Lynch and Margaret Murray discuss how people dually eligible for Medicare and Medicaid have greater need for coordinated tools and services to address social determinants of health.

This article is part of a series, produced with the support of Arnold Ventures, covering the topic of Medicare and Medicaid Integration.

As states plan to resume normal Medicaid eligibility and enrollment activity, Julia Smith and coauthors argue that randomized control trials would help optimize enrollee communications and potentially minimize coverage loss.

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