CMS Takes Steps to Improve Primary Care in America

On April 11, 2016 the Centers for Medicare & Medicaid Services (CMS) announced a large new initiative to improve primary care in America by expanding the advanced primary care medical home program, Comprehensive Primary Care (CPC) program that stared in 2012. The new program, the Comprehensive Primary Care Plus (CPC+) model will be implemented in up to 20 regions. CPC+ can accommodate over 20,000 physicians and clinicians and will serve 25 million beneficiaries. Advanced primary care medical homes are practices that transform the delivery of medical care through payment, health information technology and data. They are also accountable for the cost and quality of the care that they deliver to their patients. The foundation of this payment model is the primary care providers.

Dr. Patrick Conway, CMS deputy administrator and chief medical officer stated that “strengthening primary care is critical to an effective health care system. 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 health care system that results in healthier people and smarter spending of our health care dollars.”

CPC+ is a five-year program that will help primary care practices:

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

The CPC+ program is designed to help practices move away from the fee-for-service (FFS) reimbursement model and focus on delivering care in a manner that meets patient needs. This program is a regionally-based, multi-payer care delivery and payment model, combining both Medicare reimbursement and commercial payers. There will be two tracks to the CPC+ program. Providers will receive prospective monthly care management fees from CMS and other payers based on beneficiary risk tiers. Under Track 1 the average monthly fee will be $15 per beneficiary, whereas under Track 2 the average monthly fee will be $28 per beneficiary. Under Track 1, practices will continue to receive FFS payments from CMS. However, under Track 2, CMS is introducing a hybrid FFS and “Comprehensive Primary Care Payment” (CMCP) reimbursement.

The CPC+ program will begin on January 1, 2017 and physician practices can begin to sign up to participate in this program in July 2016.

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