Federal CMS launches multi-payer initiative to improve health care quality and cost

Wednesday, April 27, 2016 02:48 PM

The Centers for Medicare and Medicaid Services announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The agency hopes the initiative will provide doctors the freedom to care for their patients the way they think will deliver the best outcomes by paying them for achieving results and improving care.

Building on the Comprehensive Primary Care initiative launched in late 2012, the five-year CPC+ model aims to help primary care practices support patients with serious or chronic diseases, give patients 24-hour access to care and health information, deliver preventive care, engage patients and their families in their care, and work with hospitals and other clinicians to provide better coordinated care.

Primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions above, but practices in Track 2 will also provide more comprehensive services for patients with complex medical and behavioral health needs.

In Track 1, the federal 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.

Practices in both tracks will receive up-front incentive payments that they will either keep or repay based on their performance on quality and utilization metrics, which the agency hopes will encourage better health outcomes rather than higher volumes of visits or tests. Practices in both tracks also will receive data on cost and utilization.

The federal CMS will select regions for CPC+ where there is sufficient interest from multiple payers to support practices’ participation in the initiative. The agency will accept payer proposals to partner in CPC+ through June 1 and will accept practice applications in the determined regions from July 15 through Sept. 1.

Click here for more information about the CPC+ model, including a fact sheet.