The Centers for Medicare and Medicaid Services is seeking primary care practices in four selected states to apply for a second round of the Comprehensive Primary Care Plus model taking place between 2018 to 2022.
CMS has selected four regions for CPC+ Round 2 based on insurer support and other factors: Louisiana, Nebraska, North Dakota, and the Buffalo, Erie and Niagara areas of New York.
Participating primary care practices will be paid through two separate tracks that have different care delivery requirements and payment methodologies.
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But both tracks are eligible for consideration as advanced alternative payment models under the quality payment program of the Medicare Access and CHIP Reauthorization Act, or MACRA.
Eligible practices will qualify for a five percent APM incentive payment and will be excluded from the Merit-based Incentive Payment System, or MIPS, reporting requirements and payment adjustments, CMS said.
In addition, practices may get CPC+ performance-based incentive payments of up to $2.50 per beneficiary per month for Track 1 and up to $4 per beneficiary per month for Track 2.
Performance-based incentive payments are paid at the beginning of a performance year, but CMS may recoup payments if practices do not meet thresholds for quality and utilization performance.
In Track 1 of the model, practices continue to receive Medicare fee-for-service payments.
Track 2 practices are paid based on a hybrid of Medicare fee-for-service and Comprehensive Primary Care Payment.
The tracks depend on care delivery and health IT capabilities, CMS said. In each, CMS gives practices prospective monthly care management fees.
In Track 1, the Medicare fees average $15 per-beneficiary per-month across four risk tiers.
In Track 2, the Medicare fees average $28 per beneficiary per month, across five risk tiers. It also includes a $100 care management fee to support care for Medicare beneficiaries with the most complex needs.
Payer partners in CPC+ will also provide non-visit based financial supports to practices, which may use the compensation to augment staffing and add training.
Track 1 is intended for practices that have the health information technology and other basic infrastructure necessary to deliver comprehensive primary care.
Track 2 is intended for practices proficient in comprehensive primary care that are prepared to increase the depth, breadth, and scope of medical care delivered to their patients, particularly those with complex needs, CMS said.
The Medicare Comprehensive Primary Care Payment changes the cash flow mechanism for Track 2 practices. Track 2 practices receive a percentage of their expected Medicare payment for Evaluation & Management claims payment upfront quarterly, along with a reduction in Medicare fee-for-service payments for their billed E&M claims, CMS said.
CPC+ Round 2 regions were selected based on payer alignment and market density to ensure practices have sufficient payer support to make fundamental changes in their primary care delivery, CMS said.
The agency has provisionally selected to partner with seven payers in the Round 2 regions.
In addition, CMS has provisionally selected five payer partners to provide additional support in certain existing Round 1 regions.
CPC+ Round 1 began in 2017 in 14 regions, with 53 payers and 2,891 practices.
CPC+ payer partners are expected to provide practices with their own payment incentives based on quality, patient experience, utilization, and/or cost of care.
The payment redesign offers practices the ability for greater cash flow and flexibility to deliver patient-centered care and to lower the use of unnecessary services that drive total costs of care, CMS said.
The providers must be guided by functions of access and continuity, care management, comprehensiveness and coordination, patient and caregiver engagement, and planned care and population health.
For payment years 2019 through 2024, clinicians who meet the threshold for sufficient participation in Advanced APMs and who meet requirements, as applicable for 2018 onward, regarding parent organization size, are excluded from the Merit-based Incentive Payment System reporting requirements and payment adjustments.
Primary care practices in the selected regions are urged to apply for CPC+ by a deadline of July 13. CMS expects to select up to 1,000 practices.