Comprehensive Primary Care Plus regions announced

Back in April, the Centers for Medicare & Medicaid Services (CMS) unveiled its latest model of practice transformation and primary care delivery, Comprehensive Primary Care Plus (CPC+). This new model is available only for a limited time and in limited areas – but those areas have finally been announced.

CMS has selected 10 states (Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee) and four more specific regions (the Greater Kansas City region in Missouri and Kansas, the North Hudson-Capital region of New York, a region covering all of Ohio and northern Kentucky, and the Greater Philadelphia region of Pennsylvania).

CMS chose these regions based on the 57 commercial payers who CMS selected to participate in the program and who wil support CMS’s payment model. A full list of participating payers by region can be downloaded on the CMS CPC+ webpage. CPC+ is expected to involve up to 5,000 practices and more than 20,000 physicians and other clinicians serving up to 25 million patients.

Individual physicians and practices in the designated regions can apply to participate through the CPC+ Online Application Portal through Sept. 15. Practice application questions can be found in the Request for Applications.

CMS is offering additional answers to CPC+ Practice Frequently Asked Questions and webinars called Open Door Forums focused on various CPC+ program topics. The AAFP is also partnering with Caravan Health to help practices prepare for the requirements of CPC+ through Caravan Health's Boot Camp.

Physicians participating in the five-year program, which is scheduled to begin Jan. 1, must choose one of two tracks focused on care management, access and continuity, planned care for population health, patient and family caregiver engagement, and care that is comprehensive and coordinated.

While Track 1 requirements are similar to the original CPC program’s milestones, Track 2 forces participants to push the envelope in terms of using health information technology, targeting patients with complex needs, and helping meet patients’ psychosocial needs.

Physicians participating in CPC+ will receive monthly care management fees for eligible beneficiaries in their practice. Physicians in Track 1 will be paid depending on where each patient falls across four risk tiers, with an average of $15 per beneficiary per month. In Track 2, physicians will be paid according to five risk tiers, with an average of $28 per beneficiary per month, including $100 per month for the most complex patients. Practices can use these fees for increased staffing and training necessary to meet the model’s patient care requirements.

In addition to the care management fees, Track 1 physicians will continue to receive their normal Medicare fee-for-service payments. Physicians in Track 2 will receive a new hybrid of fee-for-service payments and a “Comprehensive Primary Care Payment,” which will include a percentage of the expected Medicare reimbursement for Evaluation & Management (E/M) claims upfront. Reimbursement for the E/M claims themselves will be reduced.

— Kristen Stine, Practice Transformation Strategist for the American Academy of Family Physicians