Understanding New CPC+ Model from CMS

The Center for Medicare and Medicaid Services (CMS) just released their newest initiative aimed at improving primary care. The Comprehensive Primary Care Plus (CPC+) payment model is a five year program that will begin in January 2017.  

Initial implementation will involve up to 20 regions and 5,000 practices, affecting over 20,000 providers along with their 25 million patients.

Set up as a partnership between CMS and commercial payers, as well as state and federal plans, CPC+ will rely on interest from private payers to determine where to launch. CMS will begin taking payer proposals for partnering in the program later this month. In July, they will announce the regions where the model will have its start based on payer interest. If your primary care practice is affiliated with a payer in one of the selected regions, this new payment model could affect you.

With CPC+, providers will be paid a monthly fee to manage patient care. The goal of the program is to allow greater flexibility in how practices deliver care, emphasizing improvements in quality rather than cost reduction.

Providers in selected regions can participate in 2 ways:

Track 1: Doctors and clinicians choosing this track will receive a monthly care management fee for specific services in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for Care. CMS will initially pay providers $15 per beneficiary per month for care management under Track 1.

Track 2: Under this track, providers will receive payment for monthly care management but instead of the full Medicare fee-for-service payments for evaluation and management services, they will receive reduced Medicare fee-for-service payments on top of an up-front, bundled comprehensive primary care payment. This hybrid payment model will initially pay an average monthly care management fee of $28 per beneficiary per month.

The benefit of Track 2 is that it will provide more flexibility for providers to deliver care outside of the traditional face-to-face encounter. More time can be spent on complex cases and sicker patients with in-office visits while providers can explore telehealth options for managing care in patients who are healthier.

Providers on both tracks will be eligible to receive up-front incentive payments but could face repayment of these incentives if they do not meet quality and utilization goals.

To be eligible for the incentives offered by participating in CPC+, practices must meet five requirements:

1.  Make care accessible 24/7 through enhanced in-person, telephone, and electronic access.
2. Provide proactive care to patients at the highest risk.
3. Provide comprehensive and preventative care and coordinate with specialists across the healthcare system.
4. Make care patient-centric and engage patients and their families.
5. Measure quality and utilization of services and use the data to identify opportunities for improvement.

As the latest initiative by CMS designed to improve the quality of care, CPC+ is still facing some uncertainty. The program may qualify as an alternative payment model (APM) beginning in 2019. If so, participating in CPC+ would grant practices an exemption from CMS’s Merit-based Incentive Payments System (MIPS). However, with no guidance yet from CMS as to what requirements APMs must meet, that is yet to be determined. Either way, the outlook for private practices under the new model is hopeful with CPC+ placing emphasis on improvements of care, which providers have more control over, rather than cost-cutting measures.