CMS Announces CPC+ Model to Span 14 US regions

The Centers for Medicare & Medicaid Services announced that the initial enrollment for Comprehensive Primary Care Plus (CPC+) will span 14 statewide or regional markets, allowing primary practices of all sizes to take part in the program. The CMS intends for CPC+ to reform the way basic care is delivered through improvements in care coordination, patient engagement, and preventive care

Beginning in January 2017, the five-year primary care medical home model will enable practices to care for their patients on their own terms and CMS will compensate them for achieving results and improving care. CMS estimates that 5,000 primary care practices – serving an approximately 3.5 million beneficiaries – could participate in this model. 

CPC+ is a multi-payer model which supports primary care practices by joining Medicare, state Medicaid agencies and private practice insurance companies. CMS selected the participating regions based on payer interest and coverage. Notably, CPC+ moves the health care system away from a fee-for-service model to a model that supports clinicians delivering the care that produces optimal health outcomes.

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The statewide markets selected are: Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island, and Tennessee. Furthermore, CMS selected the greater Kansas City region, covering parts of Kansas and Missouri; the North Hudson-Capital region of New York State; Ohio and Northern Kentucky; and the greater Philadelphia region in Pennsylvania.

“We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system,” Patrick Conway, MD, MSc, deputy administrator and chief medical officer at CMS, said in a press release. “This model allows primary care practices to focus on what they care about most – serving their patients’ needs when and how they choose.”

CPC+ will help primary care practices and benefit patients by:

• providing support to patients with serious or chronic diseases achieve their health goals;
• giving patients 24-hour access to care and health information;
• delivering preventive care;
• engaging patients and their families in their own care; and,
• working together with hospitals and other clinicians, including specialists, to provide better-coordinated care.

CMS will offer two tracks for CPC+ participating practices to participate in. In Track 1, CMS will pay a monthly fee to practices, in addition to the regular Medicare fee-for-service payments. In Track 2, practices will receive a monthly fee, as well as a combination of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments. Track 2 allows greater flexibility in care delivery.

Practices that participate in CPC+ may qualify for additional incentive payments which are available for the Advanced Alternative Payment Models in the proposed Quality Payment Program beginning in 2019.  

The new model supports the ongoing Administration goal to convert 50% of traditional Medicare payments to alternative payments by 2018; 30% of Medicare payments already go through alternative payments.  – Julie Gould

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