Largest Multi-Payer Primary Care Initiative Launch in America
In an effort to promote high-quality personalized health care, the Centers for Medicare and Medicaid Services (CMS) announced on April 11, 2016 the implementation of the largest-ever multi-payer plan to “transform and improve how primary care is delivered and paid for in America” (CMS Launches, 2016). According to a press release, the new plan, Comprehensive Primary Care Plus (CPC+), will serve approximately 25 million people in America.
CPC+ is designed to allow providers to provide quality, individualized patient care that includes support for chronic diseases, delivering preventative care, coordinating treatment plans with hospitals, clinicians, and specialists, and giving patients 24-hour access to care and health information. The new plan offers providers two tracks. Track one will pay on services rendered as well as pay a monthly care management fee. Practices participating in track two will receive a monthly care management fee, a hybrid reduced Medicare fee-for-services payment and an up-front comprehensive primary care payment. Additionally, there are upfront incentive programs that encourage quality care that focuses on long-term health outcomes rather than quantity of testing or visits.
Medicare will partner with commercial and state health insurance plans under the new CPC+ initiative to deliver advanced primary care. The plan encompasses five focal components: services that are accessible and responsive for patients (including enhanced in-person, online, and phone access), high-risk patients receive proactive personal services, comprehensive physical and mental health care issues are coordinated across the health care system, patient-centered, and quality and utilization of services are tracked, measured, and analyzed for improvements.
Regions will be chosen based on adequate interest from multiple payers to support the initiative. Proposals for payers to participate in the program are being accepted from April 15, 2016-June 1, 2016. Proposals for practices that would like to participate in the CPC+ program will be accepted in determined regions from July 15, 2016-September 1, 2016. As the CMC administration continues tying more and more Medicare payments to alternative payment models in the coming years, APS encourages our clients to acknowledge the ramifications of this new initiative and to consider how these practices may impact your practice in the coming years.