CMS Opens Enrollment for Value-Based Primary Care Model
Primary care practices in certain regions have until September 15 to apply for a new value-based reimbursement program.
By - CMS has opened the application period for the Comprehensive Primary Care Plus (CPC+) model, a value-based reimbursement initiative for primary care physicians in 14 areas of the country.
The application period will be open until September 15, 2016, the federal agency announced on its website.
“As a key part of CPC+, CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent, and rural practices,” said Patrick Conway, MD, CMS Deputy Administrator and Chief Medical Officer.
“We see CPC+ as the future of primary care in the US and are pleased to partner with payers across the country that are aligned in this mission to transform our healthcare system. This model allows primary care practices to focus on what they care about most – serving their patients’ needs when and how they choose.”
Eligible practices in the following regions can apply for the value-based care model through CMS:
• Arkansas: Statewide
• Colorado: Statewide
• Hawaii: Statewide
• Kansas and Missouri: Greater Kansas City Area
• Michigan: Statewide
• Montana: Statewide
• New Jersey: Statewide
• New York: North Hudson-Capital Area
• Ohio: Statewide and Northern Kentucky Area
• Oklahoma: Statewide
• Oregon: Statewide
• Pennsylvania: Greater Philadelphia Area
• Rhode Island: Statewide
• Tennessee: Statewide
Up to 5,000 primary care practices are expected to join the CPC+ initiative, CMS projected. The program is estimated to cover about 3.5 million beneficiaries across several public and private payers.
CMS announced the CPC+ program in April as an extension of the Comprehensive Primary Care Initiative that started in October 2012 and is scheduled to end this year.
The extended value-based care model was designed to reimburse primary care physicians for improving patient outcomes. Through the CPC+ program, primary care providers are expected to support patients with chronic or serious diseases, enable 24-hour access to care and health information, promote preventative care, engage patients and families, and improve care coordination efforts with other hospitals and clinicians.
Under the five-year program, CMS plans to pay participants prospective performance-based incentive payments to foster the delivery of advanced primary care processes. Based on their performance on quality and cost measures, practices will either retain the payments or refund CMS.
Participants will also be placed in one of two value-based reimbursement tracks in the CPC+ program. Practices in track one will receive a monthly fee on top of traditional Medicare reimbursements, whereas track two participants will be paid the monthly fee and receive a combination of reduced Medicare fee-for-service reimbursements and comprehensive primary care payments.
Practices in track two will also be expected to offer a wider range of services for patients with more medically complex or behavioral health needs. For example, these practices can provide systematic assessments of psychosocial needs and develop an inventory of resources to meet those needs.
The CPC+ initiative offers primary care practices stronger financial incentives than the shared savings model under the original Comprehensive Primary Care Initiative, CMS stated in a JAMA report in April.
The new model will work to provide practices with timely reimbursement payments because the original program experienced a “time lag in collecting cost data and the regional aggregation of practices required for accurate calculation of shared savings.”
CMS also reported that some practices in the CPC+ model may also qualify for financial incentives through the Advanced Alternative Payment Model track under MACRA’s proposed Quality Payment Program starting in 2019.
Additionally, CMS intends to facilitate partnerships between Medicare, state Medicaid agencies, and private insurance companies through the CPC+ initiative. The federal agency chose the recently announced regions based on payer interest and coverage.
“By aligning Medicare, Medicaid, and private insurance, CPC+ moves the healthcare 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,” stated CMS.
The CPC+ initiative is scheduled to start in January 2017.
Dig Deeper:
• Preparing the Healthcare Revenue Cycle for Value-Based Care
• What is Value-Based Care, What It Means for Providers?
