In a traditional fee-for-service payment model, providers are retroactively paid for each service rendered on a patient. The incentive for quality care is shadowed by the pressure to deliver additional services in order to receive higher reimbursements. The new Comprehensive Primary Care Plus (CPC+) value-based model is changing the way primary care practices receive payments and shifts the focus to strategies that promote coordinated, patient-centered care.
What is Comprehensive Primary Care Plus?
As of January 1, 2017, the Centers for Medicare & Medicaid Services, or CMS, has kicked off the CPC+ program. CPC+ is a model that aims to strengthen primary care through regional multi-payer payment reform that ties the provider to specific cost targets.
These 5,000 provider participants across 14 selected regions now have the ability to earn bonus fees in addition to their traditional fee-for-service rates. One of the unique aspects of CPC+ is that it is not limited to just Medicare or Medicaid beneficiaries.
The CPC+ application deadline was September 15th, 2016 and approved participants have already been selected in the following regions:
Care Delivery Requirements
CPC+’s care delivery requirements are broken out over several functional categories:
1) Access and Continuity - Expanded access to a patient’s primary care team. Expanded hours or alternatives to traditional office visits are a couple of ways that this requirement can be met. The goal is to reduce costly urgent and emergency care.
2) Care Management - The identification of high-risk, high-need patients and the provision of longitudinal care and episodic care management in order to improve outcomes for the identified patients. The use of care plans focused on goals and strategies that are aligned with the patient's values and decisions is a key requirement.
3) Comprehensiveness and Coordination - Comprehensiveness builds on the patient / provider relationship that is the center of primary care. It is the ability of a practice to meet the majority of a patient’s health and social needs in pursuit of each patient’s health goals. Achieving this goal includes the use of analytics to identify and prioritize needs of a patient population, offering services within a practice that may have previously required a referral, and facilitating care through co-management or closed-loop referrals with specialists within the community for services that are best provided outside of the primary care practice. These are key components to delivering on this requirement.
4) Patient and Caregiver Engagement - CPC+ requires patient and caregivers to be engaged in the management of their own care as well as in its design and improvement of delivery. Participating practices are expected to organize a patient and family advisory council (PFAC) to help understand the perspective of patients and caregivers on the practice and its delivery of care. Practices will use the PFAC recommendations to help them improve care delivery and ensure that a patient-centric model is maintained.
5) Planned Care and Population Health - The organization of care to meet the needs of the entire patient population a practice serves. Practices are expected to pro-actively offer timely and appropriate preventative care as well as consistent evidence-based management of chronic conditions. Population health will be improved through the use of evidence-based protocols in team-based care as well as identification of care gaps at the population level. Importantly, practices are required to measure and act on quality of care provided at the practice level.
Strengthening primary care is critical to ensuring an effective health care climate. By providing doctors and clinicians with the right tools, CPC+ participants can more readily meet their care delivery requirements. pMD’s care coordination product enables caregivers to communicate with each other about their shared patients, connects health care teams together onto one patient-centric care management platform and allows providers to send secure, HIPAA-compliant messages in real-time about their patients. By allowing providers to focus on spending more time with patients, we can continue to build a health care system that results in healthier patients and more responsible spending of health care dollars.