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 delivery transformation.
CPC+ will include two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States.
“All practices in CPC+ will receive non–visit-based care management fees paid per attributed Medicare beneficiary from CMS and per attributed member from payer partners.”
The care delivery redesign ensures practices in each track have the infrastructure to deliver better care to result in a healthier patient population. The multi-payer payment redesign will give practices greater financial resources and flexibility to make appropriate investments to improve the quality and efficiency of care, and reduce unnecessary healthcare utilization. CPC+ will provide practices with a robust learning system, as well as actionable patient-level cost and utilization data feedback, to guide their decision making.
Strengthening primary care is critical to promoting health and reducing overall healthcare costs in the U.S. CPC+ builds on the foundation of the Comprehensive Primary Care (CPC) initiative, a model tested through the Center for Medicare & Medicaid Innovation that runs from October 2012 through December 31, 2016. CPC+ integrates many lessons learned from CPC, including insights on practice readiness, the progression of care delivery redesign, actionable performance-based incentives, necessary health information technology, and claims data sharing with practices.
CPC+ will bring together CMS, commercial insurance plans, and State Medicaid agencies 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.
CPC+ will use defined, stepwise requirements to guide them through care delivery changes required to provide 5 comprehensive primary care functions: 1) access and continuity, 2) risk-stratified care management, 3) planned care for chronic conditions and preventive care, 4) patient and caregiver engagement, and 5) comprehensiveness and coordination of care. CPC+ will have a separate track (“Track 2”) for practices that have more experience delivering advanced primary care, and these practices will be expected to provide enhanced services within these 5 functions for patients with complex needs, including identification of psychosocial needs and resources and supports to meet those needs. In a novel arrangement, CMS will convene health information technology vendors supporting Track 2 practices to facilitate practices obtaining the information technology tools needed to meet the care delivery requirements of the model. CMS will provide all practices in both tracks with data on costs and utilization – ideally, aggregated with other payers – and with a learning system that helps practices redesign their care delivery and use data to improve care.
All practices in CPC+ will receive non–visit-based care management fees paid per attributed Medicare beneficiary from CMS and per attributed member from payer partners. This prospectively paid, risk-adjusted fee provides practices with financial resources to implement the processes and hire the staff needed to deliver the 5 primary care functions. In Track 2, the care management fee will average $28 per beneficiary per month but will include $100 per beneficiary per month for the patients with the most complex needs.
Practice Capabilities
Track 1
- Pathway for practices ready to build the capabilities to deliver comprehensive primary care.
Track 2
- Pathway for practices poised to increase the comprehensiveness of care through enhanced Health IT, improve care of patients with complex needs, and inventory of resources and supports to meet patients’ psychosocial needs.
Medicare Care Management Fee
Track 1
- Average Medicare care management fee of $15 per beneficiary per month.
Track 2
- Average Medicare care management fee of $28 per beneficiary per month, which includes a $100 care management fee for patients with the most complex needs.
Medicare Payment Structure
Track 1
- Practices will receive regular fee-for-service payments.
Track 2
- Practices will receive “Comprehensive Primary Care Payments (CPCP)” – a hybrid of Medicare fee-for-service and a percentage of their expected Evaluation & Management (E&M) reimbursements upfront in the form of a CPCP. Practices will receive a commensurate reduction in E&M fee-for-service payments for a percentage of claims.
Medicare Performance-Based Incentive Payment
Track 1
- Practices are eligible for a performance-based incentive payment of $2.50 per beneficiary per month. Incentive payments are prepaid at the beginning of a performance year, but practices may only keep these funds if quality and utilization performance thresholds are met.
Track 2
- Practices are eligible for a performance-based incentive payment of $4 per beneficiary per month. Incentive payments are prepaid at the beginning of a performance year, but practices may only keep these funds if quality and utilization performance thresholds are met.
Health IT Vendor Partner
Track 1
- N/A
Track 2
- Practices must submit a letter of support from their health IT vendor(s) that outlines vendors’ commitment to supporting practices with advanced health IT capabilities.
Medicare Payment Structure
Track 1
- Practices will receive regular fee-for-service payments.
Track 2
- Practices will receive “Comprehensive Primary Care Payments (CPCP)” – a hybrid of Medicare fee-for-service and a percentage of their expected Evaluation & Management (E&M) reimbursements upfront in the form of a CPCP. Practices will receive a commensurate reduction in E&M fee-for-service payments for a percentage of claims.
Multi-Payer Support
Track 1
- Practices must have support from multiple payers partnering in CPC+.
Track 2
- Payers must have support from multiple payers partnering in CPC+.
Lisa Remington is president and publisher of the Remington Report magazine and President of Remington’s Home Care Leadership Think Tank. She has worked with more than 10,000 organizations in both a consultancy role and an educator. Lisa monitors the complex key trends and forces of change to develop a correct strategic approach to de-risk decision-making and create sustainable futures across the healthcare continuum.
