Posted and filed under Payers.

Yesterday, CMS announced the next phase of their enterprising initiative to improve primary care. This nation-wide primary care model is the largest of its kind, and is known as the Comprehensive Primary Care Plus (CPC+), is a five-year primary care medical home model aimed to begin in January 2017. CPC+ plans on creating a culture in which primary care practices can care for their patients in a manner that allows them to achieve best outcomes, while paying providers for achieving these desired results and improving patient care. CPC+ will serve as a gateway for practices of diverse origin, ownership, size and structure to qualify for incentive payment Advanced Alternative Payment Models (with in the Quality Payment Program).

CPC+ is a public-private partnership dispersed amongst 14 regions, in 11 states. State-wide coverage is in the following states: Arkansas, New Jersey, Colorado, Hawaii, Michigan, Oklahoma, Oregon, Rhode Island, Montana, Tennessee. Regionally, the Greater Kansas City Region, North Hudson Capital Region (NY), Northern Kentucky Region (OH), Greater Philadelphia Region (PA) were also chosen to participate in the program. CPC+ was launched in these specified areas based on the volume of provider and payer interest and population density. Currently, there are 54 unnamed payers who have joined this partnership with CMS. Among the involved parties is New Jersey’s largest health insurer, Horizon Blue Cross Blue Shield of New Jersey.

While operating within the CPC+ initiative, CMS and other participating insurers will pay physicians a monthly fee for patient primary care visits. This model is designed to improve patient health outcomes and lower the costs for commercial health care consumers, Medicare beneficiaries, and those enrolled in plans with alternative coverage options. CPC+ is structured in such a way that two tracks have been created. Providers and practices have the option of choosing one of the two tracks for their reimbursements. Track one enables providers to receive a monthly fee for specific services in addition to the aforementioned primary care visits. Track two will allow practices to receive an upfront monthly care management fee and reduced fee for service Medicare payments. The intention of this hybrid model is to facilitated multi-faceted health care delivery, outside the realm of face-to-face visits.

The CPC+ payment model will benefit patients by supporting the primary care physicians in assisting chronically ill patients achieve their health goals, give patients 24-hour access to care and health information, increase preventative care measures, and work with clinicians to provide coordinated care that engages both patients and their families. CMS’ Chief Medical Officer, Dr. Patrick Conway has high hopes for this program mentioning; “We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system”.

Even with the promise of patient care improvement, CMS has been experiencing difficulty in gaining provider interest. The agency is accepting applications for qualifying practices until September 15, 2016 – in hopes that providers will not be deterred by care-management fees. Currently, CMS is hopeful that up to 5,000 practices, all of which who would serve an estimated 3.5 million beneficiaries, will participate in the CPC+ model.