10 Key Points in the New CMS Primary Care Payment Model

The Centers for Medicare and Medicaid Services recently announced a new primary care initiative called Comprehensive Primary Care Plus model, to improve primary care by helping practices transition to value-based care models. This model will help primary care practices work with hospitals and other clinicians, including specialists, to provide more coordinated care.

According to Patrick Conway, MD, CMS chief medical officer, “The Comprehensive Primary Care Plus model, will give doctors the freedom and flexibility to practice medicine the best way they know how, to return to what matters most to doctors and their patients. This model is shaping the future of primary care in America.”

10 Key Points of the CPC+ Model:

  1. Comprehensive Primary Care Plus model is a 5-year initiative, based on the lessons learned from the Comprehensive Primary Care initiative that was launched way back in 2012.
  2. The initiative focuses on five key functions:
    1. Access and continuity
    2. Care management
    3. Comprehensiveness and coordination
    4. Patient and caregiver engagement
    5. Planned care and population health
  3. The initiative includes two tracks, each with different requirements and payment options.
  4. In Track 1, the agency will pay a monthly fee to practices that provide specific services. That fee is in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for care.
  5. In Track 2, practices will receive a monthly care management fee and, instead of full Medicare fee-for-service payments for evaluation and management services, they will receive reduced Medicare fee-for-service payments and up-front comprehensive primary-care payments. This hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter, the CMS said.
  6. In both tracks, practices will receive upfront incentive payments that they might have to repay if they do not perform well on quality and utilization metrics. In the beginning, the CMS will pay primary care practices $15 per beneficiary per month for care management under Track 1 and an average of $28 a month under Track 2 to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries.
  7. IT will play a critical role in the CPC+ model. According to CMS, “The optimal use of Health IT and a robust learning system will support them in making the necessary care delivery changes and using the data to improve their care of patients.”
  8. The CPC+ will be implemented in up to 20 regions and include up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians. The initiative would collaborate with commercial, state, and other federal insurance plans. CMS has yet to identify regions since it must first assess interest by payers and providers.
  9. Steven J. Stack, MD, the President of American Medical Association said, “The American Medical Association has urged CMS to adopt several of these improvements as it designed the next generation of advanced primary care models. This new model holds promise for patients, and we look forward to working with CMS on its continued refinement and implementation.”
  10. Starting April 15, the CMS will solicit payer proposals to partner in CPC. Once it gets a sense of which insurers want to partner and in which regions, the CMS will solicit applications from nearby practices. That solicitation will take place between July 15 and Sept. 1, 2016.

Source: Modern Health

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