New CMS payment model largest multi-payer initiative to date, could include 20K doctors
- This morning, CMS announced its largest-ever initiative to change primary care delivery and payment in the U.S.
- The effort, the Comprehensive Primary Care Plus (CPC+) model, will be rolled out in up to 20 regions and can accommodate up to 5,000 practices, encompassing more than 20,000 providers.
- The agency will accept payer participation proposals from April 15 through June 1 and practice applications in determined regions from July 15 through September 1.
The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.
“By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists we can continue to build a healthcare system that results in healthier people and smarter spending of our health care dollars," said Dr. Patrick Conway, CMS deputy administrator and chief medical officer.
Building on the Comprehensive Primary Care initiative launched in late 2012, the five-year CPC+ model seeks to benefit patients by helping primary care practices support patients with serious or chronic diseases to achieve their health goals and work with hospitals and other clinicians, including specialists, to better coordinate care.
Primary care practices will participate in one of two tracks. In Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services.
Practices in both tracks will receive up-front incentive payments that they will either keep or repay based on quality performance and utilization metrics.
Under the CPC+ model, Medicare will partner with commercial and state health insurance plans to support primary care practices in delivering advanced primary care. Advanced primary care key components include:
- Services that are accessible, responsive to an individual’s preference, including enhanced in-person hours and 24/7 telephone or electronic access.
- Patients at highest risk receive proactive, relationship-based care management services.
- Care is comprehensive and practices can meet the majority of each individual’s physical and mental healthcare needs, including prevention. Care is also coordinated across the healthcare system and patients receive timely follow-up after emergency room or hospital visits.
- Care is patient-centered, recognizing patients and family members are core members of the care team, and actively engages patients to design care that best meets their needs.
- Quality and utilization of services are measured, and data are analyzed to identify opportunities for improvements in care and to develop new capabilities.
The determined regions have not been identified at this time. CMS will select regions for CPC+ where there is sufficient interest from multiple payers to support practices’ participation in the initiative. CMS will enter into a memorandum of understanding (MOU) with selected payer partners to document a shared commitment to align on payment, data sharing, and quality metrics in CPC+.
In March, the Administration estimated that it met the ambitious goal – eleven months ahead of schedule – of tying 30% of Medicare payments to quality and value through alternative payment models by 2016. The Administration’s next goal is tying 50% of Medicare payments to alternative payment models by 2018.
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