Monday, 08 August 2016 23:45

Floodgates Open on CPC+ Applications

Written by Mark Spivey

The Centers for Medicare & Medicaid Services (CMS) is now accepting applications to participate in the new nationwide primary care model known as Comprehensive Primary Care Plus (CPC+), opening the floodgates for what is presumed to be a significant number of interested providers.

CPC+ is a five-year primary care medical home model beginning in January 2017 that will enable primary care practices to “care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care,” CMS said in a press release published last week. The agency further described the model as “an opportunity for practices of diverse sizes, structures, and ownership who are interested in qualifying for the incentive payment for Advanced Alternative Payment Models through the proposed Quality Payment Program,” estimating that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could wind up participating when all is said and done.

A total of 14 participating regions were selected by CMS.

“CPC+ is a multi-payer model – Medicare, state Medicaid agencies, and private insurance companies partner together to support primary care practices – so CMS selected the regions based on payor interest and coverage,” the agency’s press release read. “By aligning Medicare, Medicaid, and private insurance, CPC+ moves the healthcare system away from one-size-fits-all, fee-for-service to a model that supports clinicians delivering the care that best meets the needs of their patients and improves health outcomes.”

Eligible practices in the 14 below selected regions may apply between Aug. 1 and Sept. 15, 2016:

  1. Arkansas: Statewide
  2. Colorado: Statewide
  3. Hawaii: Statewide
  4. Kansas and Missouri: Greater Kansas City
  5. Michigan: Statewide
  6. Montana: Statewide
  7. New Jersey: Statewide
  8. New York: North Hudson-Capital Region
  9. Ohio: Statewide and Northern Kentucky
  10. Oklahoma: Statewide
  11. Oregon: Statewide
  12. Pennsylvania: Greater Philadelphia
  13. Rhode Island: Statewide
  14. Tennessee: Statewide

“As a key part of CPC+, CMS and partner payors are committed to supporting primary care practices of all sizes, including small, independent, and rural practices,” said Dr. Patrick Conway, CMS deputy administrator and chief medical officer. “We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payors across the country that are aligned in this mission to transform our healthcare system. This model allows primary care practices to focus on what they care about most – serving their patients’ needs when and how they choose.”

Building on the Comprehensive Primary Care Initiative  launched in late 2012, CMS noted that CPC+ will benefit patients by helping primary care practices:

  • Support patients with serious or chronic diseases achieve their health goals;
  • Give patients 24-hour access to care and health information;
  • Deliver preventive care;
  • Engage patients and their families in their own care; and
  • Work together with hospitals and other clinicians, including specialists, to provide better-coordinated care.

Practices are being permitted to participate in one of two CPC+ tracks. In Track 1, CMS will pay providers a monthly fee in addition to regular Medicare fee-for-service payments. In Track 2, providers will receive the monthly fee as well as a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments to allow greater flexibility in how care is delivered.

Practices in Track 2 will provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of psychosocial needs and an inventory of resources and supports to meet those needs, CMS added.

“To promote high-quality and high-value care, practices in both tracks will also receive prospective performance-based incentive payments that they will either keep or have to pay back to CMS based on their performance on quality and utilization metrics,” the agency’s press release read. “In addition, practices that participate in CPC+ may qualify for the additional incentive payments available for the Advanced Alternative Payment Models in the proposed Quality Payment Program beginning (in) 2019.”

Although the development of the new model wasn’t without its pitfalls, it’s still expected to be plenty popular, Modern Healthcare reported in an article published last week.

Companies offering preferred provider organization and high-deductible plans told … CMS they could not participate in the program because of legal restrictions in many states. Some states have laws that prohibit non-HMO plans from offering capitated or risk-based payments to physicians,” the article read. “CMS (also) saw interest in fewer markets than expected. The model was supposed to launch in up to 20 regions.”

“Still,” the article went on, CMS “likely will have little trouble attracting providers since the care-management fees can be a boon for practices.” Quoting Lynn Barr, chief transformation officer at Caravan Health, Modern Healthcare reported that depending on the number of patients participating, providers can earn an additional $100,000 to $250,000 per year under the model.

Healthcare Dive noted in an article of its own on the topic that the new model – which CMS earlier this year described as its “largest ever” move to change primary care delivery and payment – furthers a fundamental shift in healthcare delivery.

The model furthers the push towards preventive care with a clear focus on primary care practices. According to the Agency for Healthcare Research and Quality … of the 624,434 physicians in the United States who spend the majority of their time in direct patient care, slightly less than one-third are specialists in primary care,” the article read. “So CMS's project could impact a large chunk of practicing providers down the line, depending on results.”

CMS further defined the model as an extension of the landmark Patient Protection and Affordable Care Act (PPACA) of 2009.

“The (PPACA), through the creation of the Center for Medicare and Medicaid Innovation, allows for the testing of innovative payment and service delivery models, such as the CPC+ model, to move our healthcare system toward one that rewards clinicians based on the quality, not quantity, of care they provide patients,” CMS said. “Today’s announcement is part of the Administration’s broader strategy to improve the healthcare system by paying providers for what works, unlocking healthcare data, and finding new ways to coordinate and integrate care to improve quality. This new model supports the Administration’s goal  to have 50 percent of traditional Medicare payments flowing through alternative payment models by 2018 (already, 30 percent of Medicare payments go through alternative models).”

For questions about CPC+ or the application process, click here or email This email address is being protected from spambots. You need JavaScript enabled to view it..

About the Author

Mark Spivey is a national correspondent for VBPmonitor.com. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

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Last modified on Tuesday, 09 August 2016 05:29