CPC+ Practice Application Now Open in Tennessee, Ends September 15th

On Aug. 1, 2016, the Centers for Medicare & Medicaid Services (CMS) opened the application for practices, including those in Tennessee, to apply for Comprehensive Primary Care Plus (CPC+), the largest-ever initiative to improve primary care in the United States.

What is CPC+

CPC+ rewards value and quality through an innovative payment structure. It is a five-year primary care medical home model beginning January 2017 that will enable primary care practices to deliver the best outcomes and be rewarded for achieving results and improving care. CPC+ is an opportunity for practices of diverse sizes, structures, and ownership who are interested in qualifying for the incentive payment for Advanced Alternative Payment Models through the proposed Quality Payment Program. CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could participate in the model.

It is a public-private partnership in 14 regions across the nation. CPC+ is a multi-payer model – Medicare, state Medicaid agencies and private insurance companies partner together to support primary care practices – so CMS selected the regions based on payer interest and coverage. By aligning Medicare, Medicaid, and private insurance, CPC+ moves the health care system away from one-size-fits-all, fee-for-service to a model that supports clinicians delivering the care that best meets the needs of their patients and improves health outcomes.

The following regions were selected for CPC+. Eligible practices in these 14 regions may apply between Aug. 1 and Sept. 15, 2016 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

Benefits

Building on the Comprehensive Primary Care initiative that launched in late 2012, CPC+ will benefit patients by helping primary care practices:

  • Support patients with serious or chronic diseases achieve their health goals
  • Give 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

Practices may participate in one of two CPC+ tracks. In Track 1, CMS will pay practices a monthly fee in addition to regular Medicare fee-for-service payments. In Track 2, practices will receive the monthly fee, as well as a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments to allow greater flexibility in how practices deliver care.

To support the delivery of comprehensive primary care, CPC+ includes three payment elements:

  1. Care Management Fee (CMF): Both tracks provide a non-visit based CMF paid PBPM. The amount is risk-adjusted for each practice to account for the intensity of care management services required for the practice’s specific population. The Medicare FFS CMFs will be paid to the practice on a quarterly basis.
  2. Performance-based incentive payment: CPC+ will prospectively pay and retrospectively reconcile a performance-based incentive based on how well the practice performs on patient experience measures, clinical quality measures, and utilization measures that drive total cost of care.
  3. Payment under the Medicare Physician Fee Schedule: Track 1 continues to bill and receive payment from Medicare FFS as usual. Track 2 practices also continue to bill as usual, but the FFS payment will be reduced to account for CMS shifting a portion of Medicare FFS payments into Comprehensive Primary Care Payments (CPCP), which will be paid in a lump sum on a quarterly basis absent a claim. Given our expectations that Track 2 practices will increase the comprehensiveness of care delivered, the CPCP amounts will be larger than the FFS payment amounts they are intended to replace.

The Affordable Care Act, through the creation of the Center for Medicare and Medicaid Innovation, allows for the testing of innovative payment and service delivery models, such as the CPC+ model, to move our healthcare system toward one that rewards clinicians based on the quality, not quantity of care they provide patients.

The CPC+ announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data and finding new ways to coordinate and integrate care to improve quality. This new model supports the Administration’s goal to have 50 percent of traditional Medicare payments flowing through alternative payment models by 2018 (already, 30 percent of Medicare payments go through alternative models).

Want to learn more about CPC+?