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What is the New Comprehensive Primary Care Plus Program?

The Comprehensive Primary Care Plus model looks to take a regional-based approach to multi-payer payment reform by offering incentives to providers offering value-based care.

By Nathan Boroyan

- The traditional fee-for-service reimbursement model is slowly being phased out in favor of value-based care, and a new advanced primary care model, called the Comprehensive Primary Care Plus (CPC+) program, will launch in 2017 to provide even greater incentives for eligible physician practices.

Comprehensive Primary Care Plus model

While the revamped model is similar to the original CPC initiative that has been available to primary care providers since 2012, the new iteration of the framework increases the opportunities for value-based risk and reward while promoting holistic population health management and coordinated care.

In this article, outlines the basics of this new option for the primary care community and explains how eligible providers can participate in the model.

What is Comprehensive Primary Care Plus?

Comprehensive Primary Care Plus (CPC+) is a new value-based, patient-centered multi-payer primary care model, announced by the Centers for Medicare and Medicaid in April. The CPC+ model focuses on strategies to promote population health management and chronic disease management techniques and encourage coordinated, patient-centered care.

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The new model is designed to help primary care practices transition to value-based payment structures by incrementally introducing them to risk-based payments in a slow and steady manner.

“Strengthening primary care is critical to an effective health care system,” said Dr. Patrick Conway, CMS deputy administrator and chief medical officer, when introducing the new option this spring.

“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.”

“The Comprehensive Primary Care Plus model represents the future of health care that we’re striving towards.”

How is CPC+ structured?

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CPC+ will allow eligible primary care practices to apply to two different financial and care quality tracks, both of which will require primary care practices to focus on practice transformation efforts across key quality improvement domains, including:

  • access and continuity
  • care management
  • comprehensiveness and coordination
  • patient and caregiver engagement
  • planned care and population health

Practices that are enrolled in Track One will receive monthly care management fees and fee-for-service payments under the Medicare Physician Fee Schedule. Track Two practices will also receive monthly care management fees, but their fee-for-service payments will be reduced. Instead, they will shoulder financial risk by attempting to make up the difference with value-based care incentives.

To promote quality care and better patient outcomes, both Track One and Track Two participants will receive their incentive payments up front. Based on the practices' performances on quality measurements, the providers will either keep these reimbursements or return them to CMS.

The incentive-based payment model will stress value-based care and encourage practices to meet quality measurements standards by placing practices at risk for prepaid amounts. The payment will be structured in two separate components: incentives for performance on clinical quality/patient experience measures, and incentives for performance on utilization measures that drive total cost of care.

What geographic areas are eligible for CPC+?

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The new model will be available to practices in 14 regions of the country, including: Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Ohio, Oklahoma, Oregon, Kansas, Missouri, New York, Rhode Island, and Tennessee.

In addition, some practices in select counties in Greater Kansas City, North Hudson-Capital, Ohio and Northern Kentucky, and Greater Philadelphia will be eligible. These 20 regions will encompass 5,000 practices, involving roughly 20,000 providers and 25 million patients.

What type of providers will benefit from participating in the model?

The CPC+ model, like other patient-centered care quality improvement programs, focuses on a patient-centered approach to care coordination, population health management, preventative services, health IT utilization, and expanded accessibility. Physician practices that have invested in big data analytics and have the appropriate infrastructure in place to put in place this approach to care – value-based over fee-for-service – will benefit from the CPC+ program.

How will primary care providers be paid in CPC+?

Practices enrolled in CPC+ will receive a risk-adjusted, prospective, monthly care management fee (CMF) for their attributed Medicare fee-for-service patients. This non-visit-based, enhanced compensation will be used to augment staffing and training in support of population health management and care coordination.

Track One practices will receive an average CMF of $15 per beneficiary per month (PBPM) to support transition efforts. Track Two practices will receive an average of approximately $28 PBPM, including a $100 PBPM for a highest risk tier (Tier 5) to support enhanced services for beneficiaries with more complex needs.

Track One practices will continue to receive their regular Medicare fee-for-service payments for covered evaluation and management services.

For track two practices, however, CMS is introducing a hybrid of fee-for-service and Comprehensive Primary Care Payment (CPCP). The hybrid value-based reimbursement will pay for covered evaluation and management services, but allows flexibility for the care to be delivered outside of a traditional office visit.

The emphasis on financial risk-sharing ties into the general federal push to promote quality over quantity and encourage providers to make themselves accountable for delivering top-level patient experiences.  As the new program unfolds and CMS eventually starts to release data about its impact on the primary care environment, healthcare organizations will be able to follow yet another signpost on the road to value-based care.


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