The Centers for Medicare and Medicaid Services is continuing its push toward wider use of value-based care with its announcement yesterday of the new Comprehensive Primary Care Plus Program.
Calling CPC+ its biggest effort to transform and improve primary care across the nation, the agency provided few specifics of how the program will work. However, details are emerging, and the direction of the program is becoming clearer.
The program is an advanced model of a primary care medical home that rewards value and quality through new payment methodologies. While the agency is not making officials available for interviews to provide details, CMS has released background information that explains how it expects the two-track program to work.
Track 1 focuses on physician practices that are in position to build the capabilities to deliver more comprehensive primary care, financially aided with an average Medicare care management fee of $15 per beneficiary per month. Physicians also may earn a performance-based monthly payment of $2.50 per beneficiary per month. Practices actually will get the incentive payments paid at the beginning of a performance year, but keep the funds only if quality and utilization performance thresholds are met. Practices participating in Track 1 must use certified electronic health records; they will continue to receive their normal Medicare fee-for-service-payments.
Track 2 is for practices that are ready to increase their health information technology capabilities to support enhanced care of patients with complex needs, which include psychosocial needs. These practices will be eligible for a monthly average Medicare care management fees of $28 per beneficiary per month, which includes a $100 care management fee for patients with the most complex needs. Practices in Track 2 must have letters of support from their information technology vendors; the letters must outline vendor commitments to enhance their IT capabilities, which includes certified EHRs.
In addition to bonus payments, Track 2 practices will receive a hybrid of Medicare fee-for-service payments and a comprehensive primary care payment. “For attributed Medicare beneficiaries, Track 2 practices will receive a percentage of their expected Medicare reimbursement for evaluation and management (E&M) claims payment upfront in the form of a CPC+ payment and reduced Medicare reimbursement amounts for E&M claims,” according to CMS.
Practices may select the track they want to start with under the CPC+ program, but CMS can ask a practice that starts with Track 2 to become a Track 1 practice if the agency does not believe that it is prepared to start with the second stage.
Participating physicians are expected to redesign their practices to support improved access and care continuity, care management, comprehensiveness and coordination, patient and caregiver engagement, and planned care and population health management.
CPC+ is a five-year program starting in January 2017. The agency also will partner with commercial insurers and state health insurance programs that commit to align payment, data sharing and quality metrics with CPC+. That means multiple programs similar to CPC+ could be offered by various payers.
Payers can submit proposals to partner with CPC+ from April 15 through June 1. Physician practices can apply to participate in selected regions from July 15 through September 1.