Applications are Now Open for the Federal Comprehensive Primary Care Plus Program

Primary care practices can start applying now for participation in the nationwide Centers for Medicare & Medicaid Services (CMS) primary care medical home model, known as Comprehensive Primary Care Plus, or CPC+. The application process runs through September 15.

CPC+ is a five-year model, set to begin January 2017, that would enable primary care practices to care for their patients in a manner that they think will deliver the best outcomes and pay them for achieving results and improving care. CMS estimates that up to 5,000 practices serving an estimated 3.5 million beneficiaries could participate in the model.  

CPC+ is a public-private partnership in 14 regions across the United States, and as a multi-payer model, utilizing Medicare, state Medicaid agencies and private insurance companies, the goal is to move the healthcare system from its current fee-for-service model to one that supports clinicians delivering the best care for their patients to improve health outcomes.

CMS selected the regions based on payer interest and coverage, and Ohio (including northern Kentucky) is one of the regions. Here are the others:

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

The new program builds on the Comprehensive Primary Care initiative that launched in late 2012. Ohio is a participant of that program, and to read an announcement from Gov. John Kasich’s office concerning updates about the program as well as how it ties into the new CPC+ program, click here. CPC+ will further benefit patients by helping practices support patients with serious or chronic diseases so they can achieve their health goals, give patients around-the-clock access to care and health information, deliver preventive care, engage patients and their families in their own care, and work with hospitals and other clinicians to provide better-coordinated care. 

Practices may participate in one of two CPC+ tracks. Both tracks will be paid a monthly fee in addition to regular Medicare fee-for-service payments. However, Track 2 participants will also receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments, to allow greater flexibility in how they deliver care. Because Track 2 practices will provide more comprehensive services for patients with complex medical and behavioral health needs, they will receive the appropriate resources and support to meet those needs based on assessments.

As an incentive to provide high-quality and high-value care, participants in both tracks will also receive prospective performance-based incentive payments, which they will either keep or pay back to CMS based on their performance on quality and utilization metrics. Participants will also qualify for the additional incentive payments available for the Advanced Alternative Payment Models in the proposed Quality Payment Program that will begin in 2019.

The Affordable Care Act 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. This new model program supports the Administration’s goal to have 50% of traditional Medicare payments flowing through alternative payment models by 2018 (and 30% already do).

To view the CMS web page dedicated to the CPC+ initiative, click here. Or for questions about the program or application process email CPCplus@cms.hhs.gov.

Also, the local nonprofit organization CliniSync has offered to assist with technology services for physicians who choose to participate in this program. To learn more about their services, go to www.clinisync.org and Sign Up For Services. 



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