CPC +

Comprehensive Primary Care Plus (CPC+) is a new value-based, patient-centered multi-payer primary care model, announced by the Centers for Medicare and Medicaid in April. The CPC+ model focuses on strategies to promote population health management and chronic disease management techniques and encourage coordinated, patient-centered care.

Quillen ETSU Physicians is one of nearly 2,900 primary care practices nationwide participating in Comprehensive Primary Care Plus (CPC+), a partnership between payer partners from the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, commercial health plans, self-insured businesses, and primary care providers. This partnership is designed to provide improved access to quality health care at lower costs.

“A robust primary care system is essential to achieve better care, smarter spending, and healthier people,” said Acting CMS Administrator Patrick Conway. “For this reason, CMS is committed to supporting primary care clinicians to deliver the best, most comprehensive primary care possible for their patients.”

For patients, this means that physicians may offer longer and more flexible hours; use electronic health records; coordinate care with patients’ other health care providers; better engage patients and caregivers in managing their own care; and provide individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

The five-year model started on January 1, 2017, with CMS soliciting a diverse pool of commercial health plans, state Medicaid agencies, and self-insured businesses to work alongside Medicare to support comprehensive primary care. Public and private health plans in 14 regions across the country signed letters of intent with CMS to participate in this model: Arkansas, Colorado, Hawaii, Kansas and Missouri’s Greater Kansas City region, Michigan, Montana, New Jersey, New York’s Capital District-Hudson Valley region, Ohio and Kentucky’s Cincinnati-Dayton region, Oklahoma, Oregon, Pennsylvania’s Greater Philadelphia Region, Rhode Island, and Tennessee. The markets were selected in August 2016 based on the percentage of the total population covered by payer partners who expressed interest in joining this partnership.

Eligible primary care practices in each market were invited to apply to participate in the winter of 2016. Through a competitive application process, CMS selected primary care practices within the selected markets to participate in CPC+. Practices were chosen based on their use of health information technology; ability to demonstrate recognition of advanced primary care delivery by leading clinical societies; service to patients covered by participating payer partners; participation in practice transformation and improvement activities; and diversity of geography, practice size, and ownership structure.

CPC+ is administered by the Center for Medicare & Medicaid Innovation (CMS Innovation Center). The CMS Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care.

For more information about CPC+, visit:
https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus/

PRINCIPLES OF CPC+

COMPREHENSIVE PRIMARY CARE PLUS

Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. CPC+ includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States (U.S.). There are 2,891 primary care practices participating in Comprehensive Primary Care Plus.

BACKGROUND

Through a unique public-private partnership with 54 aligned payers in 14 regions (PDF), the CPC+ payment redesign gives practices the additional financial resources and flexibility they need to make investments that will improve quality of care and reduce the number of unnecessary services their patients receive. CPC+ provides practices with a robust learning system, as well as actionable data feedback, to guide their decision making. The care delivery redesign ensures practices in each track have the infrastructure to deliver better care to result in a healthier patient population.

CPC+ is a five-year model: Round 1 will begin in January 2017 and Round 2 will begin in January 2018.

MODEL DETAILS

Beginning in January 2017, CPC+ supports 2,891 primary care practices, comprising 13,090 clinicians and serving more than 1.76 million Medicare beneficiaries. Practices of all sizes and structures are located in each of the 14 CPC+ regions: Arkansas, Colorado, Hawaii, Greater Kansas City Region of Kansas and Missouri, Michigan, Montana, North Hudson-Capital Region of New York, New Jersey, Ohio and Northern Kentucky Region, Oklahoma, Oregon, Greater Philadelphia Region of Pennsylvania, Rhode Island, and Tennessee.

CPC+ seeks to improve the quality of care patients receive, improve patients’ health, and spend health care dollars more wisely. Practices in both tracks will make changes in the way they deliver care, centered on key Comprehensive Primary Care Functions: (1) Access and Continuity; (2) Care Management; (3) Comprehensiveness and Coordination; (4) Patient and Caregiver Engagement; and (5) Planned Care and Population Health.