- On Monday, CMS announced the 14 regions selected for its new nationwide primary care model, Comprehensive Primary Care Plus (CPC+)
- 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.
- In addition, the agency opened up the application period for practices to participate in the five-year primary care medical home model.
Eligible practices in these 14 regions may apply between August 1 and September 15 to participate in CPC+:
1. Arkansas: Statewide
2. Colorado: Statewide
3. Hawaii: Statewide
4. Kansas and Missouri: Greater Kansas City Region
5. Michigan: Statewide
6. Montana: Statewide
7. New Jersey: Statewide
8. New York: North Hudson-Capital Region
9. Ohio: Statewide and Northern Kentucky Region
10. Oklahoma: Statewide
11. Oregon: Statewide
12. Pennsylvania: Greater Philadelphia Region
13. Rhode Island: Statewide
14. Tennessee: Statewide
CMS announced in April the CPC+ initiative, calling the effort its "largest-ever" move to change U.S. primary care delivery and payment.
The model furthers the push towards preventive care with a clear focus on primary care practices. According to the Agency for Healthcare Research and Quality, in 2010 there were approximately 209,000 practicing primary care physicians in the U.S., adding, "Of the 624,434 physicians in the United States who spend the majority of their time in direct patient care, slightly less than one-third are specialists in primary care."
So CMS' project could impact a large chunk of practicing providers down the line depending on results. The agency touts the medical home model is part of broader efforts to push to rewarding quality over quantity. CMS set a goal for itself to have 50% of traditional Medicare payment transactions going through alternative payment models by 2018; 30% of such payments already do.
The model was forecasted to be rolled out up to 20 regions and hoping to accommodate up to 5,000 practices, potentially including more than 20,000 providers.
In the August 1 announcement, the agency stuck to it's estimate that up to 5,000 primary care practices could participate in the model, potentially serving around 3.5 million beneficiaries.
In May, CMS released two fact sheets on the initiative with one announcing that ACOs would be allowed to participate in the model.
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.