It is well-known that delivering patient-centered, comprehensive primary care is hard work. However, if you’re a primary caregiver, and your care team is ready to enhance the care you deliver for all of your patients, particularly those with complex needs, then the Comprehensive Primary Care Plus (CPC+) might be the right APMs model for your practice to join.
The CPC+ Model brings together payers and clinicians to change the way primary care practices have been doing business for decades. Primary care clinicians want to provide the best care possible for their patients. They want to ensure their patients have access to care and build long-term relationships. They want to more closely manage the health of their high-risk patients. They want to provide comprehensive services to their patients within their practice and be able to connect patients to high-value providers outside their practice. They want to engage patients and their caregivers to be active, not only in their own health but also in the improvement of the practice itself. And they want to have data that drives their quality improvement efforts and informs how to best care for their patient population.
CPC+ provides the tools, financial support, and guidance for practices to spend more time with patients to deliver the best care possible and improve the healthcare system. CPC+ works to move practices one step closer to placing patient relationships at the center of what primary care clinicians do every day.
The CPC+ model is organized into two tracks based on practice capabilities and readiness to jump into the work. The way you implement CPC+ will reflect your specific patient population and the organizational structure. In the first year of CPC+,
• Track 1 practices will enhance important areas of their work while developing a foundation for team-based care by empaneling their entire population of patients and ensuring that patients have 24/7 access to care informed by the electronic health record. Practices in Track 1 will also segment and stratify that patient population according to patient risk, to develop the capability for providing proactive relationship-based care management to those at highest risk. These practices will use payer data to understand where their patients are receiving care and to focus coordination efforts on hospital transitions and high-volume specialists. Practices in Track 1 will work to engage patients and families through advisory councils in the design of care that best meets their needs. Finally, Track 1 practices will review utilization data provided by payers to guide practice change overall.
• Track 2 practices will strengthen all the capabilities mentioned for Track 1, while they also advance further. They will deepen their patients’ access to primary care by expanding the opportunities for care outside the traditional office visit. Track 2 practices will refine their risk stratification process and use care plans for these patients to assure the provision of care is consistent with the patient’s goals and wishes. They will increase their ability to coordinate the care of their population by enacting collaborative agreements with specialists. To address their patient’s psychosocial needs practices will begin to integrate behavioral healthcare into their practice and inventory community and social supports. Track 2 practices will empower their patients to manage their chronic conditions successfully by developing practice capability for support of self-management. Practices will leverage the whole care team to develop quality improvement strategies that use cost and utilization data.
In the CPC+ model, practices will receive aligned supports from Medicare and other health insurance companies, CPC+ payer partners whose members they serve. Financial supports will not be identical across payers but will be coordinated within the CPC+ framework to position practices to achieve optimal health outcomes. It is important to note that practices will remain in the same track throughout the five-year model. However, practices may withdraw from the model without penalty during the five-year program period. Practices are required to notify CMS at least 90 calendar days before the planned day of withdrawal.
There are three payment innovations in CPC+ which depart from the traditional fee for service system and can help support patient-centered care.
1. Care Management Fee (CMF): Both tracks provide a non-visit based CMF paid 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 Fee-For-Service CMFs will be paid to the practice on a quarterly basis
2. Performance-Based Incentive: CPC+ will prospectively pay and retrospectively reconcile a performance-based incentive payment 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:
a. Track 1 continues to bill and receive payment from Medicare FFS as usual.
b. Track 2 practices also continue to bill as usual, but the FFS payment for evaluation and management services 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 without a claim. Given the 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.
You can learn much more about the CPC+ Model for the APMs track by visiting the web page CMS has provided located here: CPC+ Model. The page also provides a link to the practice application portal as well as other training information that could be helpful.