What Is It?– Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through a regionally - based multi - payer payment reform and care deli very transformation. CPC+ will include 2 primary care practice tracks with incrementally advanced care delivery requirements and payment options.
CPC+ will bring together CMS, commercial insurance plans and State Medicaid to provide the financial support necessary for practices to make fundamental changes in their care delivery. CMS will enter into a Memorandum of Understanding (MOU) with selected payer partners to document a shared commitment to align on payment, data sharing and quality metrics throughout the five-year initiative.
When? – CPC+ is a five-year model that will begin in January 2017.
Who?– CPC+ will affect primary care providers in 14 designated regions (see list below)
• Arkansas: Statewide
• Colorado: Statewide
• Hawaii: Statewide
• Kansas and Missouri: Greater Kansas City Region
• Michigan: Statewide
• Montana: Statewide
• New Jersey: Statewide
• New York: North Hudson-Capital Region
• Ohio: Statewide and Northern Kentucky: Ohio and Northern Kentucky Region
• Oklahoma: Statewide
• Oregon: Statewide
• Pennsylvania: Greater Philadelphia Region
• Rhode Island: Statewide
• Tennessee: Statewide
How? – The goal of CPC+ is to improve the quality of care patients receive, improve patients’ health and spend healthcare dollars more wisely. Practices in both tracks will make changes in the way they deliver care, centered on the key Comprehensive Primary Care Functions:
1) Access and Continuity
2) Care Management
3) Comprehensiveness and Coordination
4) Patient and Caregiver Engagement
5) Planned Care and Population Health
To support the delivery of comprehensive primary care, CPC+ includes 3 payment elements:
1) Care Management Fee (CMF): Both tracks provide a non-visit based CMF paid PBPM (per beneficiary per month). 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 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.
|CPC+ Financial Summary Table|
|Track||Care Mgmt Fees; Performance-Based PBPM||Performance-Based PBPM Incentive Payments||Visit and Non-Visit Based Payments|
|1||$15 average||Utilization & Quality/Experience Components||CMF + FFS|
|2||$28 average; $100 for Utilization & Quality/Experience complex||Utilization & Quality/Experience Components||CMF + ⇩ FFS + ⇧ CPCP|
How To Apply: Eligible practices within the 14 regions may apply to participate in CPC+ until September 15, 2016. Practices applying to Track 2 will need to submit a letter of support from their Health IT Vendor that outlines the vendor’s commitment to supporting the practice with advanced health IT capabilities. CMS will sign a Memorandum of Understanding with those health IT vendors supporting Track 2 practices selected to participate in CPC+.
CPC+ Online Application Portal: app1.innovation.cms.gov/cpcplus
CPC+ Help Desk: 8:30am-7:30pm EST at (844) 442-2672 or CPCplus@cms.hhs.gov
CMS CPC+ Program Overview: https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus
CPC+ Payer FAQ: innovation.cms.gov/files/x/cpcplus-payersolicitationfaq.pdf
CPC+ Payer List by Region: innovation.cms.gov/Files/x/cpcplus-payerregionlist.pdf
To Download Global Vendor Letter of Support for CPC+: Global Vendor Letter of Support for CPC+.pdf