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CMS launches initiative to improve primary care

The Centers for Medicare and Medicaid Services (CMS) recently announced its largest-ever initiative to transform and improve the way primary care is delivered and paid for in America. The new Comprehensive Primary Care Plus (CPC+) model is a regionally based, multipayer care delivery and payment model that includes two tracks.

According to this press release, each track will require practices to:

  • Support patients with serious or chronic diseases to achieve their health goals.
  • Provide patients 24-hour access to care and health information.
  • Deliver preventive care.
  • Engage patients and their families in their own care.
  • Work together with hospitals and other clinicians, including specialists, to provide better coordinated care.

The CPC+ model will include monthly care management fees for eligible beneficiaries in a physician’s practice. Physicians in Track 1 will be paid depending on where each patient falls across four risk tiers, with an average of $15 per beneficiary per month. In Track 2, payments are paid based on five risk tiers, with an average of $28 per beneficiary per month, including $100 per month for the most complex patients. Practices may use the enhanced, non-visit based payments in ways that meet the needs of their attributed patients.

In addition to the care management fees, physicians in Track 1 will continue to receive their usual Medicare fee-for-service payments. Physicians who opt for Track 2 will receive a new hybrid of fee-for-service payments and a CPC+ payment that will include a percentage of the expected Medicare reimbursement for Evaluation and Management (E/M) claims up-front. Reimbursement for the E/M claims themselves will be reduced.

CMS will implement CPC+ in up to 20 regions of the country, where there is sufficient interest from multiple payers to support practices’ participation in the initiative. CPC+ can accommodate up to 5,000 practices, which would encompass more than 20,000 physicians and other clinicians and the 25 million patients they serve.

CMS is accepting payer proposals to partner in CPC+ between April 15 and June 1, 2016. It will accept practice applications in the determined regions from July 15 through Sept. 1, 2016.

For more information about the CPC+ model, including a fact sheet and answers to frequently asked questions, click here.

Back to April 28, 2016 Medigram