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Comprehensive Primary Care Plus (CPC+) is a CMS incentive program aimed at improving patient health and outcomes by augmenting the way Primary Care Physicians get paid. The first round of the program begins in January 2017, and will add monthly Care Management Fees, the standard Medicare Fee Schedule based payments, as well as incentive payments based on performance in the program.
The program strives to reduce healthcare costs by taking proactive steps to keep patient populations healthy, decreasing unnecessary healthcare utilization. This will then provide practices and providers with greater financial flexibility, and the ability to make investments towards higher-quality and more efficient care.
The program will be monitored over 5 years, along 2 tracks with slightly different payment structures, with yearly milestones that progressively create a robust foundation for participating practices to provide improved patient care, and take an analytical approach to medical decision making.
CMS has divided the core goals of CPC+ into five categories:
|Access and Continuity||Because health care needs and emergencies are not restricted to office operating hours, primary care practices optimize continuity and timely, 24/7 access to care guided by the medical record. Practices track continuity of care by provider or panel.|
|Planned Care for Chronic Conditions and Preventive Care||Participating primary care practices proactively assess their patients to determine their needs and provide appropriate and timely chronic and preventive care, including medication management and review. Providers develop a personalized plan of care for high-risk patients and use team-based approaches like the integration of behavioral health services into practices to meet patient needs efficiently.|
|Risk-Stratified Care Management||Patients with serious or multiple medical conditions need extra support to ensure they are getting the medical care and/or medications they need. Participating primary care practices empanel and risk stratify their whole practice population, and implement care management for these patients with high needs.|
|Patients and Caregiver Engagement||Primary care practices engage patients and their families in decision-making in all aspects of care, including improvements in the system of care. Practices integrate culturally competent self-management support and the use of decision aids for preference sensitive conditions into usual care.|
|Coordination of Care Across the Medical Neighborhood||Primary care is the first point of contact for many patients, and takes the lead in coordinating care as the center of patients’ experiences with medical care. Practices work closely with patients’ other health care providers, coordinating and managing care transitions, referrals, and information exchange.
CMS intends to roll out the restructured payment system in roughly 5000 practices, across the following 14 carefully selected regions.
These regions, outlined in detail here, were carefully selected based on the success in the initial CPC program, by payer participation, and by market density. This ensures that the practices chosen to participate will have ample support from public and private payers.
CMS elected to target primary care exclusively because of its historic lack of adequate funding, and because of the vast number of Americans who utilize their PCP as their sole or primary resource in managing their health. This is also coupled with the original CPC program’s success, which included both significant total saving, zero increased cost, and positive quality results. The improvement came so quickly, and was so apparent that CMS eagerly launched the new program to accommodate a wider range of more diverse practices.
CPC+ is based around taking a value-based approach to patient care, and the payment structure directly reflects this. While billing will still be done normally via the Standard Medicare Fee Schedule, two additional forms of payment are added, which reward continuous, planned, and preventative care.
These two forms are Care Management Fees, which are Per-Beneficiary Per-Month (PBPM) fees, that are based on each patient’s risk level and complexity, and Comprehensive Primary Care Payments (CPCP), which are quarterly payments based on all services rendered. While Track 2 practices will see a decrease in fee-schedule based payments (FFS), they are expected to receive a greater amount in CPCP payments than the difference.
Part of Elation’s philosophy is not only to improve the provider’s experience while using their Clinical EHR, but also to improve the patient’s care, and strengthen the relationship between providers and patients. We believe that this initiative aligns these goals, and has the potential to nourish these relationships, while also providing much needed support to Primary Care Providers.
Beginning January 1st, 2017, CPC+ participants must have adopted an eligible EHR, which specifically includes meeting certain Clinical Quality Measure (CQM) requirements, as well as having committed to future CPC+ milestones. Elation already meets the requisite certification criteria, and supports the necessary CQMs. We have also submitted a Global Letter of Support to CPC+ and are included in CMS’s CPC+ Vendor List.
This letter of support becomes important at the first and second milestones of the program (January 1st, 2018, and January 1st, 2019) when additional technical requirements are needed for CPC+ participants.
To support CPC+ participants, Elation has invested in the needed tools and support to help participants succeed and get the most out of CPC+. Elation’s powerful Collaborative Health Record includes the workflow improvements, reporting capabilities, and collaboration tools required to support physicians throughout this program. In addition to technology support, Elation has launched a series of timed updates which outline our plan to address the requirements for CPC+, guided webinars to answer questions, and an on-demand health policy team.