The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative to transform how primary care is delivered and paid for in America. Building on the Comprehensive Primary Care initiative, the new Comprehensive Primary Care Plus (CPC+) model will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve.
CMS said participating practices would receive data on cost and utilization, and that optimal use of health IT and a robust learning system would be essential in supporting them in making care delivery changes and using the data to improve their care of patients.
The five-year CPC+ model is designed to help primary care 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; and
• Work together with hospitals and other clinicians, including specialists, to provide better coordinated care.
Primary care practices will participate in one of two tracks. Practices in Track 2 will provide more comprehensive services for patients with complex medical and behavioral health needs.
In Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. This hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter.
According to CMS, Track 2 practices’ vendors will sign a Memorandum of Understanding (MOU) with CMS that outlines their commitment to supporting practices’ enhancement of health IT capabilities. These partnerships “align with the Office of the National Coordinator for Health IT priority to ensure electronic health information is available when and where it matters to consumers and clinicians,” CMS said in a release.
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 this model encourage doctors to focus on health outcomes rather than the volume of visits or tests, CMS said.
“Strengthening primary care is critical to an effective health care system,” said Patrick Conway, M.D., CMS deputy administrator and chief medical officer. “By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars. The Comprehensive Primary Care Plus model represents the future of health care that we’re striving towards.”
CMS said it would select regions for CPC+ where there is sufficient interest from multiple payers to support practices’ participation in the initiative. CMS will enter into MOUs with selected payer partners to document a shared commitment to align on payment, data sharing, and quality metrics in CPC+. CMS will accept payer proposals to partner in CPC+ from April 15 through June 1, 2016. CMS will accept practice applications in the determined regions from July 15 through Sept. 1, 2016.