CMS has launched a new “Comprehensive Primary Care Plus” (CPC+) model to improve how primary care is delivered and reimbursed. According to CMS, the CPC+ initiative (which builds on the ongoing Comprehensive Primary Care model) will provide “greater cash flow and flexibility for primary care practices to deliver high quality, whole-person, patient-centered care and lower the use of unnecessary services that drive total costs of care,” which in turn will result in a healthier patient population.
Through the five-year CPC+ model, Medicare and commercial and state payers will partner in up to 20 regions to support eligible practices as they change how they delivery care, focusing on (1) Access and Continuity; (2) Care Management; (3) Comprehensiveness and Coordination; (4) Patient and Caregiver Engagement; and (5) Planned Care and Population Health. CMS expects that the model will include up to 5,000 practices with more than 20,000 doctors and clinicians serving 25 million beneficiaries.
Practices can apply to participate in one of two tracks with different payment options and clinical capability requirements, as summarized in the following CMS chart:
|Track 1||Track 2|
|Practice Capabilities||Pathway for practices ready to build the capabilities to deliver comprehensive primary care.||Pathway for practices poised to increase the comprehensiveness of care through enhanced Health IT, improve care of patients with complex needs, and inventory of resources and supports to meet patients’ psychosocial needs.|
|Medicare Care Management Fee||Average Medicare care management fee of $15 per beneficiary per month.||Average Medicare care management fee of $28 per beneficiary per month, which includes a $100 care management fee for patients with the most complex needs.|
|Medicare Payment Structure||Practices will receive regular fee-for-service payments.||Practices will receive “Comprehensive Primary Care Payments (CPCP)” – a hybrid of Medicare fee-for-service and a percentage of their expected Evaluation & Management (E&M) reimbursements upfront in the form of a CPCP. Practices will receive a commensurate reduction in E&M fee-for-service payments for a percentage of claims.|
|Medicare Performance-Based Incentive Payment||Practices are eligible for a performance-based incentive payment of $2.50 per beneficiary per month. Incentive payments are prepaid at the beginning of a performance year, but practices may only keep these funds if quality and utilization performance thresholds are met.||Practices are eligible for a performance-based incentive payment of $4 per beneficiary per month. Incentive payments are prepaid at the beginning of a performance year, but practices may only keep these funds if quality and utilization performance thresholds are met.|
|Health IT Vendor Partner||N/A||Practices must submit a letter of support from their health IT vendor(s) that outlines vendors’ commitment to supporting practices with advanced health IT capabilities.|
|Multi-Payer Support||Practices must have support from multiple payers partnering in CPC+.||Payers must have support from multiple payers partnering in CPC+.|
CMS will select regions for CPC+ where there is sufficient interest from multiple payers to support practices’ participation in the initiative. CMS plans to enter into a Memorandum of Understanding with selected payer partners covering payment, data sharing, and quality metrics requirements applicable to the CPC+ model.
CMS will accept payer proposals from April 15 through June 1, 2016, and CMS will accept practice applications in the determined CPC+ regions from July 15 through September 1, 2016. The first performance period for CPC+ begins on January 1, 2017. CMS will host a series of webinars in April and May for interested stakeholders.