Brief

CMS selects 4 more regions for CPC+

Dive Brief:

  • The CMS announced Wednesday the four regions it has selected for the Comprehensive Primary Care Plus (CPC+) Round 2 and the health insurance companies that will participate. They join the 54 payers in 14 regions that were selected for Round 1 last year.
  • The goal with the payment redesign model is to improve health outcomes while lowering costs.
  • The agency expects to have up to 1,000 primary care practices participating in CPC+ Round 2. 

Dive Insight:

The healthcare industry is moving toward value-based care and clinicians will feel increasingly pressured to improve the quality of care they provide as the federal government continues to tie this to more and more of their payments. Coordinating with payers and IT companies makes it easier for care delivery organizations, especially small and solo practices, to overcome all of the new challenges during the transition.

Health IT companies have created and launched devices with the purpose of helping providers prepare for the Quality Payment Program and improve outcomes, though EHR vendors still have a long way to go to make their systems more user-friendly. The incentive for payers to try to help as best they can during the transition is their need for building and maintaining a network of quality providers in their competitive market. 

The CMS' public-private partnership initiatives have been helping participating practices across the U.S. to improve on meeting quality of care requirements since 2012. Results for the second round of the CPC initiative in 2015 showed $57.7 million gross savings were generated in Part A and Part B expenditures. The agency has yet to publish any results for CPC+, which it began to roll out in April 2016.

Mark Hefner, CEO of Infina Connect Healthcare Systems, recently told Healthcare Dive that the original "CPC program appeared to decrease unnecessary hospitalizations and [emergency department] visits.” Hefner thinks that "CPC+ offers significant opportunity to redesign care and deliver higher value coordinated care at a lower cost.”

On the other hand, Julie Simer, special counsel in Buchalter Nemer’s healthcare practice group, argued that the initial results with the previous CPC model "showed that savings were not sufficient to cover the incentives." 

The regions selected for CPC+ Round 2 — based on payer alignment and market density — are Louisiana, Nebraska, North Dakota and the Greater Buffalo Region of New York. The participating payers are BlueCross BlueShield of WNY, Blue Cross Blue Shield of Louisiana, Amerigroup Louisiana, Inc., AmeriHealth Caritas Louisiana, Inc., Blue Cross Blue Shield of Nebraska, Blue Cross Blue Shield of North Dakota and Independent Health Association, Inc.

A missing piece in the Round 2 puzzle is the practices. Those that are not eligible are practices that didn't apply for Round 1, those that did apply and weren't accepted, as well as those that are not in the selected regions. 

Practices in the selected regions have until July 13 to fill out an application for participating in either Track 1 or Track 2 of CPC+ Round 2 from January 2018 through 2022. Track 2 is intended for practices that can meet six health IT requirements, which include producing and displaying the results of electronic clinical quality metrics to support actionable feedback for decision-making.

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Filed Under: Payer Policy & Regulation