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CMS Expands Comprehensive Primary Care Plus to New Regions

The Comprehensive Primary Care Plus model is growing to four new regions in an effort to offer value-based population health management to more high-needs patients.

Comprehensive primary care plus program

Source: Thinkstock

By Jennifer Bresnick

- CMS has announced the expansion of the Comprehensive Primary Care Plus (CPC+) program to four new regions, adding to a successful primary care model that serves patients with complex needs.

Eligible participants in Louisiana, Nebraska, North Dakota, and the Greater Buffalo Region of New York State will be able to join Round 2 of the CPC+ from 2018 to 2022.

They will join nearly 2900 practices and 53 payers in 14 other regions, including Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Ohio, Oklahoma, Oregon, Kansas, Missouri, New York, Rhode Island, and Tennessee.

“CPC+ Round 2 regions were selected based on payer alignment and market density to ensure that CPC+ practices have sufficient payer supports to make fundamental changes in their primary care delivery,” CMS said in an email to newsletter subscribers. 

“CMS has provisionally selected to partner with seven payers in these regions throughout Round 2 of the model. In addition, CMS has provisionally selected five payer partners to provide additional support in certain existing Round 1 regions.”

The program, which began earlier in 2017, offers primary care providers the chance to build their population health management skills while benefiting from financial incentives that can prepare them for value-based care. 

Participants in both Track 1 and Track 2 of the CPC+ receive prospective care management payments, although Track 2 practices have their fee-for-service reimbursements reduced to increase the incentive to cut costs.

“Strengthening primary care is critical to promoting high quality, patient-centered care, and reducing overall health care costs in the US,” said CMS in its announcement.

“The Comprehensive Primary Care Plus (CPC+) model is an advanced primary care medical home model that rewards value and quality by offering an innovative payment structure to support primary care practices to improve quality, access, and efficiency.”

Participants in the model, which qualifies as an Advanced Payment Model (APM) under the MACRA framework, will work towards achieving five core primary care improvement goals, including care access and continuity, care management, coordination of services, patient and family engagement, and population health management.

The five-year initiative requires primary care providers to leverage health IT tools to meet a series of benchmarks within these broad categories, such as using feedback from payers to assess clinical quality measures, following up with patients after an emergency department visit or hospital discharge, and stratifying patients by risk.

Participants must use Certified EHR Technology (CEHRT) to support their efforts, and are expected to be able to report on electronic clinical quality measures.  Track 2 participants must also work with their health IT vendors to develop advanced analytics and population health management capabilities within their infrastructure.

Practices upload regular reports on their progress through a web portal, and can take advantage of CMS resources such as data feedback, learning communities, and best practices on the regional and national level.

In the initial incarnation of the program, 95 percent of practices serving approximately 376,000 Medicare beneficiaries met their quality benchmarks, resulting in $57.7 million in savings, CMS said in 2016.

Patients also experienced slightly higher rates of satisfaction with their care, found a study in the American Journal of Managed Care.  Patients receiving care at CPC+ providers were more likely to be satisfied with the timeliness of appointments, provider communication, and patient empowerment than those who visited other facilities.

“Strengthening primary care is critical to an effective health care system,” said Dr. Patrick Conway, who is currently serving as CMS Deputy Administrator for Innovation and Quality.

“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 healthcare dollars.”

Eligible practices located in Louisiana, Nebraska, North Dakota, or Erie and Niagara Counties in New York may apply for the CPC+ program until July 13, 2017

Application information is available on the CMS website by clicking here.


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