Comprehensive Primary Care Plus – Medicare Doubles Down

April 30, 2016

CMS, through its Centers for Medicare and Medicaid Innovation (CMMI), is rolling out a refined version of an innovation model that is just winding down its four-year run.


CMS, through its Centers for Medicare and Medicaid Innovation (CMMI), is rolling out a refined version of an innovation model that is just winding down its four-year run. Per CMMI, the Comprehensive Primary Care (CPC) initiative

is a four-year multi-payer initiative designed to strengthen primary care. Since CPC’s launch in October 2012, CMS has collaborated with commercial and State health insurance plans in seven U.S. regions to offer population-based care management fees and shared savings opportunities to participating primary care practices to support the provision of a core set of five “Comprehensive” primary care functions. These five functions are: (1) Risk-stratified Care Management; (2) Access and Continuity; (3) Planned Care for Chronic Conditions and Preventive Care; (4) Patient and Caregiver Engagement; (5) Coordination of Care across the Medical Neighborhood. The initiative is testing whether provision of these functions at each practice site — supported by multi-payer payment reform, the continuous use of data to guide improvement, and meaningful use of health information technology — can achieve improved care, better health for populations, and lower costs, and can inform future Medicare and Medicaid policy.

Comprehensive Primary Care Plus (CPC+) is slated to go live January 2017. (CPC+ presser, CPC+ RFA, summary of CPC+ IT requirements). Per CMMI,

the five-year CPC+ model will benefit patients by helping primary care practices:

  • Support patients with serious or chronic diseases to achieve their health goals
  • Give patients 24-hour access to care and health information
  • Deliver preventive care
  • Engage patients and their families in their own care
  • Work together with hospitals and other clinicians, including specialists, to provide better coordinated care

Primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions and meet the criteria listed above, but practices in Track 2 will also 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.

CPC+ will help practices move away from one-size-fits-all, fee-for-service health care to a new system that will give doctors the freedom to deliver the care that best meets the needs of their patients. In Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. This hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter.

A recently published study of the CPC model showed that, after two years, CMS got (statistically speaking) zero bang for its buck. (Follow the link above to Jaan Sidorov’s post about the study and the model on the Population Health Blog; he discussed it with Joe Paduda and me as part of a recent Health Wonk Review on Air Blab).

I’ll be discussing the CPC+ model on today’s #hcbiz Tweetchat and Blab with co-hosts Don Lee and Shahid Shah, and PCPCC President Marci Nielsen. Join us live at 12 noon ET on Twitter and at 12:30 on Blab (both accessible via the link live and as a replay).

David Harlow
The Harlow Group LLC
Health Care Law and Consulting


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