The Centers for Medicare and Medicaid Services (CMS) has announced another new innovation model for Medicare beneficiaries, the Comprehensive Primary Care Plus (CPC+) model, intended to continue the quality improvements achieved through the multi-payer CPC begun in 2012 in seven regions, with about 500 participating practices. The model will be considered an alternative payment model (APM) to advance progress on the U.S. Department of Health and Human Services goal of linking 50 percent of Medicare fee-for-service payments to APMs by the year 2018.
CMS will first accept applications from other payers (for example, state Medicaid programs and commercial payers) to align with the CPC+ model. CMS believes that like the CPC, the CPC+ model will work best where there is alignment among multiple payers in a region/market, using similar quality measures and payment incentives.
After CMS determines where it would have appropriate payer partners to implement this multi-payer model (expected by July 2016), then CMS will accept applications from Medicare fee-for-service providers in those regions to agree to one of the two alternative payment “tracks”. CPC+ Track 1 will remain primarily a fee-for-service payment but participating providers will be eligible for an additional care management fee of $6 to $30 per Medicare beneficiary per month (depending on the health risk scores of the beneficiaries) as well as an additional, pre-paid incentive payment of $2.50 per beneficiary per month for achieving quality improvement goals (the incentive payment must be returned if the quality improvement goals are not met). CPC+ Track 2 providers will be eligible for a care management fee of $9 to $100 per Medicare beneficiary per month (with higher health risk scores among their patients), incentive payments of $4 per beneficiary per month, an up-front capitated payment for estimated evaluation and management fees (“comprehensive primary care payments”), and then fee-for-service payments for any non-evalaution and management claims. Track 2 providers also must secure agreements with their health IT vendors for electronic health record systems that will support the documentation and reporting required to calculate the payments. These higher care management fees and incentive payments, as well as moving most evaluation and management fees to a capitated rate, make Track 2 a risker payment model for providers.
The quality and utilization measures will reflect CMS’ model for Comprehensive Primary Care and will address five areas of improvement: (1) Access and Continuity; (2) Care Management; (3) Comprehensiveness and Coordination; (4) Patient and Caregiver Engagement; (5) Planned Care and Population Health.
CMS plans to designate approximately 20 regions to enroll about 2,500 participating providers in Track 1 and another 2,500 providers in Track 2. CMS estimates that this will mean the participation of 20,000 clinicians and 25 million Medicare beneficiaries in the model. CPC+ will be launched in 2017, and will be a five-year initiative.
Here is the Request for Application for payer partners:
Here is a Frequently Asked Questions about the CPC+:
CMS will be conducting a series of informational webinars to describe the CPC+ initiative.