CMS Releases a New Primary Care Initiative: Value-Based Care Model
This value-based care model is designed to better coordinate care with specialists that eventually will help primary care doctors and clinicians spend time with their patients and serve their needs outside of the regular office visit hours.
Key Attributes
The CPC+ five year model was built from the Comprehensive Primary Care Initiative which was originally launched in 2012. There are five main areas of focus of advanced primary care as follows:
| Planned care and population health: Quality and usage of services is always being measured and analyzed for improvements and development of further capabilities. |
| Patient and caregiver engagement: Advanced care is patient-centered, and includes family members as part of the care team. Programs are designed to best meet the patients’ needs. |
| Comprehensiveness and coordination: Care is comprehensive and meets most of the physical and mental healthcare needs. It can be accessed across the healthcare system, including specialty care and community services where patients receive timely follow-up after emergency room and hospital visits. |
| Care management: Patients at highest risk receive proactive, relationship-based care management services to improve outcomes. |
| Access and continuity: Accessible services with phone and electronic access available 24/7. |
CMS states that this model will help primary care providers work with specialists, hospitals and other clinicians to provide more coordinated patient-centered care. Under CPC+, CMS will partner with both commercial insurers and Medicaid agencies to provide monthly care management fees based on patient risk tiers.
Financial Tracks
Primary care practices will have the option of engaging in one of two financial tracks that are available. Both tracks require implementation of risk-based, slow and incremental payments; however, track two also provides a value-based reimbursement model that places a heavy reliance on value; not just risk. Participants in both tracks will receive up-front incentive payments that they will keep or repay to CMS based on their performance on utilization and quality metrics.
Track One: CMS will pay an average monthly care management fee of $15 per patient. This will be in addition to the fee for service payments from the Medicare Physician Fee Schedule. There are also potential performance-based patient incentive payments of $2.50 per month.
Track Two: This track is for practices with more comprehensive services for patients with complex medical and behavioral needs. These practices will receive average monthly care management fees of $28 per patient. They will receive a hybrid of reduced Medicare fee-for service payments and upfront comprehensive primary care payments. In addition, they are also eligible for potential performance-based incentive payment of $4 per patient.
Technology Requirements
CPC+ will require health IT usage in order to make the necessary changes to support the clinical workflow. There will be a significant amount of focus placed on health IT and, in order to receive support from the IT vendors, certain practices will be required to submit a letter outlining vendor commitments. This will ensure the availability of quick access to electronic health information for both consumers and clinicians.
Implementations
This model is set to be implemented in January of 2017. CPC+ will expand in up to 20 different regions nationwide and will include 5,000 practices. There will be more than 20,000 providers with a total of 25 million patients. CMS will select regions for CPC+ in areas supported by multiple payers. In order to be considered for participation, prospective healthcare payers were required to submit proposals between April 15 and June 1. Once the regions are selected, practices that wish to participate must submit applications to CMS between June 15 and September 1.
Conclusion
The Patient Centered Primary Care Collaborative has stated that CPC+ is the future of the healthcare industry through its help in shifting primary care practices to value-based models and that it encourages the type of comprehensive primary care that not only leads to more effective, efficient, and patient-centered care but also embraces value.
Steven J. Stack, M.D., President of the American Medical Association stated, “The American Medical Association has urged CMS to adopt several of these improvements as it designed the next generation of advanced primary care models. This new model holds promise for patients, and we look forward to working with CMS on its continued refinement and implementation.”
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The information contained herein is not necessarily all inclusive, does not constitute legal or any other advice, and should not be relied upon without first consulting with appropriate qualified professionals for your individual facts and circumstances.
