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Aetna Joins CMS’ CPC+ Primary Care Initiative in Pennsylvania

February 27, 2017
by Rajiv Leventhal
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Aetna announced last week that it would collaborate with other health plans in its region and local primary care practices as part of the federal government’s Comprehensive Primary Care + (CPC+) initiative.

In April 2016, the Centers for Medicare & Medicaid Services (CMS) announced a new initiative with the aim to transform how primary care is delivered and paid for in America. Building on the Comprehensive Primary Care initiative from 2012, the new CPC+ model is a five-year primary care medical home model that began in January 2017 that will  aim to enable primary care practices to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care, CMS said.

Then in August, CMS announced the 14 regions in which practices will be eligible to apply for CPC+, with southeastern Pennsylvania, where Aetna is based, being one of them. Indeed, the program unites insurance plans in the tracking and reporting of healthcare quality and improvement data. Aetna, along with other participating plans, will provide the combined financial support needed by physician practices to make fundamental changes in the way they deliver care for Medicare beneficiaries, the health insurer said in a statement.

“Aetna’s Medicare network in southeastern Pennsylvania includes a number of primary care practices that provide care that is consistent with the quality demanded by the CPC+ program. Furthering the number of practices who can achieve those goals and helping our members access this level of care is consistent with our intention to offer Medicare Advantage plans that achieve high quality ratings of 4 stars or better from CMS,” Robert O’Connor, executive director, Aetna Medicare, Pennsylvania, said in a statement.

In the April announcement, 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. And, according to CMS, Track 2 practices’ vendors will sign a Memorandum of Understanding (MOU) with the agency 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 (ONC) priority to ensure electronic health information is available when and where it matters to consumers and clinicians,” CMS said. There are two tracks in the program of which participants can choose from.

This past January, CMS said that some 359,000 clinicians are confirmed to participate in four of CMS’ Alternative Payment Models (APMs) in 2017, with one of the APMs being the CPC+ model, for which the federal agency is partnering with 54 payers in 14 regions with 2,893 primary care practices which include over 13,000 clinicians, in 2017. CMS also recently announced CPC+ Round 2, with participation beginning in 2018. Federal officials expect that by the 2018 performance year, 25 percent of clinicians in the Quality Payment Program, within the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be participating in an Advanced APM and eligible to earn APM incentive payments.

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