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.

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Report Says Physician Engagement is Greatest Challenge for Healthcare Executives

by Skip Leavitt and Kimberly Buser, JHD Healthcare Partners

HealthLeaders recently published an insightful report on physician alignment, centering on strategies that require both risk and clinical integration. The article notes that physician engagement is the greatest need, and also the greatest challenge, for health system executives: it’s highest on the list of objectives, at 66 percent, and is most frequently cited as being the most difficult.
Some other key findings from the report include:
• The survey showed 66 percent of respondents engage physicians in quality initiatives. And, 24 percent say engagement is the most difficult part of aligning physicians. Physicians know that the goal is delivering higher-quality, lower-cost healthcare, but they are often resistant to change. A proactive change management plan is needed to help the physicians achieve their goals.
• Clinical integration is often cited as a mechanism for health systems to gain physician alignment. For employed physicians, 55 percent of health systems use clinical integration, and for independents, 52 percent, according to the HealthLeaders report. This movement can be an important way to align with physicians on common ground, but it cannot succeed in isolation.
• Executives are expecting a 48 percent growth in clinically integrated medical staff over the next three years – the same staff that are expected to provide a high level of coordination of care, but only if they are properly engaged.
The successful organizations we work with realize that to really engage physicians in the alignment effort, the entire health system needs a philosophical shift to a culture of inclusion. They also have a detailed action plan to guide the change process on all levels. We recommend that clients provide a flexible range of alignment options including employment, participation in clinically integrated networks, or through a “fabric” of supporting physician practice services.
Creating a plan for successful alignment often includes these practices:
• Implement a robust physician engagement and communication program that is bi-directional, inclusive and transparent
• Provide a robust clinical and non-clinical education program
• Establish physician support capabilities as good, or better than, what is available in the market elsewhere for them.
Lots of people talk about physician alignment. But let’s discuss how it can be one of your organization’s main strategies for success. Give JHD Healthcare Partners a call today at 972-220-0474.
To download your free copy of the HealthLeaders article, click here.