Medicare announces a new program to pay primary care practices for managing their own patients

On April 11, 2016 CMS announced Comprehensive Primary Care Plus (CPC+), a significant advancement of an earlier program known as CPC that was launched in 2012.

The new initiative is open to primary care practices that do not participate in other types of comprehensive care programs such as ACOs, including MSSPs.

A unique feature of CPC+ is that CMS wants to include other types of health insurance plans, in addition to Medicare, to participate so that the majority of a practice’s patients are covered.  This will reduce the complexity for participating practices and will create enough of a critical mass to make participation viable.

The CPC+ design is intended to provide partial up-front funding, added to FFS payments, and backward looking quality performance rewards to practices who actively manage the health of a panel of patients.  Many details have yet to be explained, but the Medicare component will contain two Tracks.  Track 1 is intended for practices who want to develop comprehensive care capabilities.  It is less demanding than Track 2, but also comes with lower $PMPM and performance rewards.  The prospective $PMPM will be risk stratified under both Tracks, with the methodology still to-be-determined.  As an example, under Track 1, a primary care practice with an average risk score will receive:

  • Full FFS reimbursement, billed as usual
  • Plus, a $15 PMPM, paid in advance
  • Plus, up to $2.50 PMPM based on quality performance

For a practice with 300 Medicare beneficiaries, the $PMPM payments could amount to $63,000 per year on top of any FFS dollars received.

Track 2 is designed for PCPs who are already advanced in their PHM efforts.  Compensation under Track 2 follows a similar structure, but the amounts have been increased to reflect the additional effort and resources needed.

Commercial and other health plans will need to develop their own parallel programs and coordinate with CMS so that practices can achieve economy of scale by including most, if not all, of their patients.

The next step for the CPC+ program is for CMS to receive applications for participation from insurance in order to define the participating regions.  The regions will be announced in June.  At that time practices who are in a participating region can submit their applications.   Participating practices will be announced in October.

Find out more at http://bit.ly/1sAdIfm.

 

 

 

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