The Centers for Medicare and Medicaid Services opened the application period for practices to participate in a new, nationwide primary care model dubbed Comprehensive Primary Care Plus, naming 14 regions where the new innovation model will take place.
CPC+ is a five-year primary care home model, beginning January 2017, that will enable primary care practices to care for their patients in the way in which they think will deliver the best outcomes -- and to pay those practices for achieving results and improving care. CMS touts CPC+ as an opportunity for practices of diverse sizes, structures and ownership who are interested in qualifying for the incentive payment for Advanced Alternative Payment Models through the proposed Quality Payment Program.
CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could participate in the model.
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CPC+ is a public-private partnership in 14 regions across the nation. It is a multi-payer model: Medicare, state Medicaid agencies, and private insurance companies partner together to support primary care practices. CMS selected the regions based on payer interest and coverage.
According to the agency, by aligning Medicare, Medicaid and private insurance, CPC+ moves the healthcare system away from a its fee-for-service model to one which supports clinicians delivering the care that best meets the needs of patients.
Eligible practices in 14 regions can apply between August 1 and Sept. 15 to participate in CPC+. Those regions include the greater Kansas City region of Kansas and Missouri; the North Hudson-capital region of New York; the greater Philadelphia area; and statewide in Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Ohio, Oklahoma, Oregon, Rhode Island and Tennessee.
Building on the Comprehensive Primary Care initiative that launched in late 2012, CPC+ aims to benefit patients by helping primary care practices give patients 24-hour access to care and health information, as well as deliver preventative care and better coordinate with other hospitals and clinicians.
Practices can participate in one of two CPC+ tracks. In Track 1, CMS will pay practices a monthly fee in addition to regular Medicare fee-for-service payments. In Track 2, practices will receive the monthly fee, as well as a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments, to allow greater flexibility in how practices deliver care.
Practices in Track 2 will provide more comprehensive services for patients with complex medical and behavioral health needs, including -- as appropriate -- a systematic assessment of their psychosocial needs and an inventory of resources and supports to meet those needs.
To promote quality and high-value care, practices in both tracks will also receive prospective performance-based incentive payments that they will either keep or have to pay back to CMS, based on their performance on quality and utilization metrics. In addition, practices that participate in CPC+ may qualify for the additional incentive payments available for the Advanced Alternative Payment Models in the proposed Quality Payment Program beginning in 2019.
This new model supports the Obama Administration's goal to have 50 percent of traditional Medicare payments flowing through alternative payment models by 2018. Already, 30 percent of Medicare payments go through alternative models, according to CMS.