CPC+, Medicare’s new payment model for primary care

CPC+, Medicare’s new payment model for primary care

On Monday, the CMS announced the 14 regions that are eligible to participate in their five-year primary-care quality improvement initiative which allows practices to test out the new nationwide primary care model, Comprehensive Primary Care Plus (CPC+), which was announced in April.

Those regions:

  • Arkansas: Statewide
  • Colorado: Statewide
  • Hawaii: Statewide
  • Kansas and Missouri: Greater Kansas City Region
  • Michigan: Statewide
  • Montana: Statewide
  • New Jersey: Statewide
  • New York: North Hudson-Capital Region
  • Ohio: Statewide and Northern Kentucky: Ohio and Northern Kentucky Region
  • Oklahoma: Statewide
  • Oregon: Statewide
  • Pennsylvania: Greater Philadelphia Region
  • Rhode Island: Statewide
  • Tennessee: Statewide

The initiative is being dubbed the “largest-ever” move to change US primary care delivery and payment and was designed in part to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care, according to CMS.

Goals of CPC+

The CPC+ model brings together Medicare, commercial insurance, and state-run insurance plans to support primary care practices in delivering the key components of advanced primary care.

  • Care is accessible and responsive to a patient’s preference, including enhanced in-person hours and 24/7 telephone and online access.
  • High-risk patients will receive proactive, relationship-focused care management.
  • Practices take a comprehensive approach to meeting the majority of an individual’s physical and mental health needs, including prevention.
  • Care is coordinated across healthcare systems and individuals receive timely follow-up after hospital or emergency room visits.
  • Patient-centered care is emphasized and patients and family members are recognized as core members of the care team and are actively engaged to design care that best meets their needs.
  • The quality and utilization of care is measured and data is analyzed to optimize care and develop new capabilities.

How technology supports CPC+

In order to understand and assess care quality, CMS requires practices to adopt a CPC+ ready EHR that is capable of adopting many of the following workflow changes:

  • Utilizing an IT-enabled, patient-centered care planning tool
  • Tracking patients over time
  • Administering surveys and tracking survey status
  • Linking results to care plans
  • Triggering interventions based on results

Eligible practices within the 14 regions may apply to participate in CPC+ from August 1 – September 15, 2016.

Click here to apply.