Health Law Daily Applications open for CPC+, largest-ever primary care initiative
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Tuesday, August 2, 2016

Applications open for CPC+, largest-ever primary care initiative

By Patricia K. Ruiz, J.D.

CMS’ largest-ever initiative to improve primary care, the Comprehensive Primary Care Plus (CPC+) model, which enables primary care practices to take ownership of providing the best care for patients and pays them for achieving results and improving care, will begin January 2017. Eligible practices located within 14 participating regions may submit applications between August 1 and September 15, 2016. The model involves the participation of Medicare and other payers, primary care practices, and health information technology vendors.

Rewarding value and quality. CPC+ offers an innovative payment structure that supports the delivery of comprehensive primary care. The model contributes to goals set by the Obama Administration of having 50 percent of all Medicare-fee-for-service payments made via alternative payment models by 2018. It was created by the CMS Innovation Center, which was established under section 3021 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).

CPC+ is a regionally based, multi-payer care delivery and payment model that offers two tracks with different care delivery requirements and payment methodologies, which is aimed at meeting the diverse needs of primary care practices. The payment redesign will allow for greater cash flow and flexibility for practices to deliver high-quality, whole-person, patient-centered care, while reducing use of unnecessary services that increase the cost of care. Practices will be expected to make changes in care delivery over key functions: (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and (5) planned care and population health.

Changes in payments. Under CPC+, payments will be affected in the following ways:

  • CMS will provide monthly care management fees, which practices may use to support augmented staffing and training that may be needed to meet the model requirements.
  • Track 1 practices will continue to receive Medicare fee-for-service payments, while Track 2 practices will receive a hybrid of Medicare fee-for-service payment and Comprehensive Primary Care Payment (CPCP), which changes the cash flow mechanism for the practices to promote flexibility and require practices to increase the depth and breadth of the primary care delivered. CPC+ payer partners should make changes in underlying payment structures by 2018 to align with the goals of the CPCP.
  • CMS will reward practices with incentive payments based on performance over patient experience, clinical quality, and utilization measures. Performance payments will be paid prospectively at the beginning of the performance year, and CMS will recoup payments if practices do not meet thresholds for quality and utilization performance. Payer partners are also expected to provide practices with similar incentives.

Eligibility regions. Applications may be submitted by practices in the states of Arkansas, Colorado, Hawaii, Kansas and Missouri (Greater Kansas City region), Michigan, Montana, New Jersey, New York (North Hudson-Capital region), Ohio, Northern Kentucky, Oklahoma, Oregon, Pennsylvania (Greater Philadelphia region), Rhode Island, and Tennessee.

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