Health Reform WK-EDGE CMS announces largest ever primary care initiative
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Thursday, April 14, 2016

CMS announces largest ever primary care initiative

By Bryant Storm, J.D.

CMS’ new Comprehensive Primary Care Plus (CPC+) initiative will reform primary care payment and delivery across up to 5,000 practices, encompassing as many as 20,000 physicians and clinicians. The initiative, which will be the largest of its kind, builds upon the existing Comprehensive Primary Care (CPC) initiative, by using monthly care management fees as well as incentive payments to encourage providers to provide higher quality and better coordinated care. Payments under the CPC+ initiative will be aimed at rewarding physicians who focus on outcomes rather than on the volume of patient visits or tests. The model will last five years after it begins in January 2017.

Innovation. The CPC and CPC+ were developed by the Center for Medicare and Medicaid Innovation (CMMI), which was created by Section 3021 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). Since the CPC initiative was launched in 2012, the program has involved collaboration with 38 commercial and state health insurance plans to support 500 primary care practices in testing comprehensive primary care payment and delivery.

CPC+. The CPC+ initiative builds on its predecessor by using two tracks. In both tracks, providers will receive prospective monthly care management fees (CMFs) based upon risk tiers, with an average CMF payment of $15 per beneficiary per month (PBPM) for providers in the first track and an average CMF payment of $28 PBPM for the second track, which includes a $100 CMF to support care for patients with the most complex needs. While providers in track one will continue to receive fee for service (FFS) payments, providers in the second track will receive a hybrid of Medicare FFS payments and the Comprehensive Primary Care Payment (CPCP). The CPCP hybrid is designed to alter primary care provider cash flows to allow for greater flexibility in how primary care is delivered.

Incentives. CMS will also make incentive payments under CPC+. The incentive payments will be $2.50 PBPM for Track 1 and $4 PBPM for Track 2. However, the agency will recoup all or a portion of a provider’s incentive payments if the provider fails to meet thresholds for patient experience, clinical quality, and utilization measures.

Participation. Eligible practices in as many as 20 regions around the country can apply for participation in one of the two CPC+ tracks. The potential 2,500 practices that the program will accommodate could encompass as many as 25 million patients. Among other capabilities, eligible practices must demonstrate multi-payer support and use of Certified EHR Technology (CEHRT).

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