IT to play big role in CMS’s new physician payment model

Information technology is a critical component of a just-announced Centers for Medicare and Medicaid Services initiative to revamp care delivered by primary care physicians. CMS describes the initiative, Comprehensive Primary Care Plus, as its biggest effort to transform and improve primary care.

With CPC+, the CMS is creating a new payment model aimed at incenting doctors to produce better health outcomes. CMS says the goal is to improve healthcare quality and cost while enabling physicians and patients to have more control over care delivery.

Key to the transformation will be the ability of physicians and consumers to take advantage of IT to unlock healthcare data and move to value-based payment models, supported by improved communication and the use of technology to coordinate care. IT will be a crucial enabler of expansions of service, such as serving patients’ healthcare needs outside of the physician office and sharing patient information to better coordinate care among care team members.

The new model will give physicians incentives to work with patients to achieve better outcomes. It aims to better support patients with serious or chronic conditions; give patients 24-hour access to health information; deliver preventive care; engage patients and families in care; and work with other providers to improve care coordination.

CMS plans to roll out a large test of the CPC+ program. It expects it to accommodate 5,000 physician practices, and says it could potentially impacting more than 20,000 clinicians and 25 million patients nationwide.

The program will have two tracks from physicians can choose. In Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for evaluation and management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. CMS believes the hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter.

Practices participating in both tracks will receive data on cost and utilization. “The optimal use of Health IT and a robust learning system will support them in making the necessary care delivery changes and using the data to improve their care of patients,” CMS says.

The program also will require a commitment from the companies that sell software to physicians enrolled in the track that involves more care management. “Track 2 practices’ vendors will sign a Memorandum of Understanding (MOU) with CMS that outlines their commitment to supporting practices’ enhancement of health IT capabilities. These partnerships will be vital to practices’ success in the care delivery work and align with the Office of the National Coordinator for Health IT priority to ensure electronic health information is available when and where it matters to consumers and clinicians.”

Early reactions from provider organizations have been positive. The American Medical Association quickly noted its support, saying that the new initiative is on the right track by focusing on improved patient care.

“At first glance, this new payment model initiative includes several advances over the current primary care model, particularly because it emphasizes improvements in care that are achievable by primary care physicians instead of cost reductions that are beyond their control,” said a statement by Steven J. Stack, MD, president of the AMA.

“We look forward to reviewing the proposal in detail and working constructively with CMS to ensure physicians have flexible and workable payment models that support high-quality patient care and put less administrative burden on physician practices to alleviate physician burnout,” Stack added. “The American Medical Association has urged CMS to adopt several of these improvements as it designed the next generation of advanced primary care models. This new model holds promise for patients, and we look forward to working with CMS on its continued refinement and implementation.”

Participating primary care practices can participate in one of two tracks, with incrementally advanced care delivery requirements and payment options. Healthcare information technology will play an integral role in both tracks, which are designed to give patients 24-hour access to care and health information.

CMS will accept practice applications to participate in CPC+ from July 15 through September 1.

The experiment will include entities other than providers. Under the CPC+ model, Medicare will partner with commercial and state health insurers to support practices in delivering advanced primary care. CMS says it will also enter into an MOU with select payers to document a shared commitment to align on payment, data sharing and quality metrics. CMS will accept payer proposals to partner in CPC+ from April 15 through June 1.

“By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists, we can continue to build a healthcare system that results in healthier people and smarter spending of our healthcare dollars,” said Patrick Conway, MD, CMS deputy administrator and chief medical officer.

CMS says its intent is to help practices move away from “one-size-fits-all, fee-for-service healthcare to a new system that will give doctors the freedom to deliver care that best meets the needs of their patients.”

CMS says that advanced primary care is a model of care with five key components:

Services are accessible, responsive to an individual’s preference, and patients can take advantage of enhanced in-person hours and 24/7 telephone or electronic access.
Patients at highest risk receive proactive, relationship-based care management services to improve outcomes.
Care is comprehensive and practices can meet the majority of each individual’s physical and mental health care needs, including prevention. Care is also coordinated across the health care system, including specialty care and community services, and patients receive timely follow-up after emergency room or hospital visits.
It is patient-centered, recognizing that patients and family members are core members of the care team, and actively engages patients to design care that best meets their needs.
Quality and utilization of services are measured, and data is analyzed to identify opportunities for improvements in care and to develop new capabilities.

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