Comprehensive Primary Care Plus (CPC+)

AAFP Embraces Largest Initiative to Test Physician Payment Model

April 13, 2016 10:51 am News Staff
[New project gears]

On April 11, CMS announced plans to launch what it called the "largest-ever initiative" aimed at improving how primary care is delivered and how America's primary care physicians are paid for their services.

According to a CMS press release, the initiative -- dubbed the Comprehensive Primary Care Plus (CPC+) model -- is a five-year test model that will begin in January 2017.

The initiative will be launched in as many as 20 still-to-be-determined regions of the country and could pull in some 20,000 physicians and other health care professionals and affect as many as 25 million patients. It will build on the successes of the Comprehensive Primary Care initiative that launched in 2012 and in which a number of family physicians have participated.

CMS noted in the statement that the initiative would give physicians the latitude to care for and manage their patients. The ultimate goal is attainment of the best possible outcomes for patients' health, and in return, CMS will pay physicians "for achieving results and improving care."

Story Highlights
  • CMS just announced plans to launch the Comprehensive Primary Care Plus initiative, which will test a new physician care delivery and payment model.
  • The initiative will take place in as many as 20 regions of the country and involve some 20,000 physicians and health care professionals and as many as 25 million patients.
  • The AAFP supports the initiative because it will lead to high quality care for patients and better payment for family physicians.

CMS Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., called strengthening primary care "critical" to achieving an effective health care system.

"By supporting primary care doctors and clinicians to spend time with patients, service patients' needs outside of the office visit and better coordinate care with specialists, we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars," he said.

AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., cheered the announcement. She noted in an AAFP statement that U.S. health care consumers have made it clear that they want a revamped health care system that will provide them with "comprehensive, efficient and virtually seamless health care."

The AAFP supports comprehensive, coordinated and continuous primary care, said Filer, but that kind of comprehensive health care requires significant investments on the part of America's physicians.

"Physicians who are redesigning their practices must purchase or upgrade electronic health records, reconfigure or add medical office staff, and commit additional time for communication with subspecialists, pharmacists, hospitals, home care agencies and therapists," said Filer.

Dates to Remember

Has recent news of CMS' Comprehensive Primary Care Plus initiative piqued your interest? Keep these dates in mind:

It's clear to the AAFP that the financial and emotional effort family physicians put into these redesigns and upgrades must be supported by new payment models, she added.

"These services and the supporting payment models are vital to ensuring that patients get the right care from the right health professional at the right time," she said.

Filer noted the AAFP's long-standing commitment to transitioning from episodic fee-for-service payment to a blended payment model that supports family physicians in providing direct patient care as well as coordinating and managing patient care.

The CPC+ initiative offers physicians blended payment and, importantly, invites both public and private payers to the table, said Filer. That combination ensures that CPC+ will be another important step "toward transforming the way patients get care, the quality and efficiency of that care and the overall improvement of health in the community," said Filer.

What You Need to Know

When news of the CPC+ initiative was announced, the AAFP immediately went to work sifting through the details to pull out the most important details for family physicians.

For instance, the AAFP describes the initiative as a five-year, regionally-based, multi-payer, advanced primary care medical home model.

The model includes two separate tracks in which physicians can participate. According to CMS, practices can apply to the track for which they think they are ready, but CMS can offer practices entrance to track one if they do not meet eligibility requirements for track two.

CMS and other payers who choose to participate will pay prospective monthly care management fees to practices in both tracks; those fees will be based on beneficiary risk tiers. According to CMS charts, the average per-beneficiary per-month (PBPM) fee is $15 for practices in track one and $28 for practices in track two.

There are other significant differences between the two tracks. Specifically, track-one practices will receive Medicare fee-for-service payments; track-two practices will be paid a hybrid of Medicare fee-for-service and a global payment for evaluation and management services.

In addition, both tracks have four risk tiers, but track two includes a fifth "complex" risk tier that includes a $100 care management fee to help support physicians who care for patients with more complex needs.

Furthermore, practices will be rewarded for their performance on patient experiences, clinical quality and utilization measures through performance-based incentive payments ($2.50 PBPM for track one, $4 PBPM for track two).

If a practice does not meet quality thresholds for electronic clinical quality and patient experience, and for utilization performance, CMS will take back all -- or a portion of -- the advance prepayments made to that practice.

The AAFP will provide more information about CPC+ to family physicians as it becomes available.

More From CMS

In conjunction with the CPC+ announcement, CMS also released a number of supporting documents to help physicians digest the details.

Review questions and answers in an FAQ document(innovation.cms.gov) and learn more about

  • why CMS launched the initiative,
  • where CPC+ will be implemented,
  • how the initiative will measure the improvement in quality of care for and experience of care by patients,
  • what learning and technical assistance supports CPC+ will offer to participating practices,
  • how the model will be evaluated and
  • what will happen with practices currently participating in the original CPC initiative.

CMS also posted a fact sheet(www.cms.gov) with additional information.

And be sure to read an article titled "Medicare’s Vision for Advanced Primary Care: New Directions for Care Delivery and Payment"(jama.jamanetwork.com) that was published in the JAMA: the Journal of the American Medical Association the same day the initiative was announced.

Additional Resource
CMS: Comprehensive Primary Care Plus(innovation.cms.gov)


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