CMS Announces Next Phase in Largest-Ever Initiative to Improve Primary Care in America

August 12, 2016
Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Practice Management

The Centers for Medicare & Medicaid Services (CMS) recently opened the application period for practices to participate in the new nation-wide primary care model, Comprehensive Primary Care Plus (CPC+). CPC+ is a five-year primary care medical home model beginning January 2017 that will enable primary care practices to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care. CPC+ is an opportunity for practices of diverse sizes, structures, and ownership who are interested in qualifying for the incentive payment for Advanced Alternative Payment Models through the proposed Quality Payment Program. CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could participate in the model.

CPC+ is a public-private partnership in 14 regions across the nation. CPC+ is a multi-payer model - Medicare, state Medicaid agencies, and private insurance companies partner together to support primary care practices - so CMS selected the regions based on payer interest and coverage. By aligning Medicare, Medicaid, and private insurance, CPC+ moves the health care system away from one-size-fits-all, fee-for-service to a model that supports clinicians delivering the care that best meets the needs of their patients and improves health outcomes.

The following regions were selected for CPC+. Eligible practices in these 14 regions may apply between August 1 and September 15, 2016 to participate in CPC+:

  1. Arkansas: Statewide
  2. Colorado: Statewide
  3. Hawaii: Statewide
  4. Kansas and Missouri: Greater Kansas City Region
  5. Michigan: Statewide
  6. Montana: Statewide
  7. New Jersey: Statewide
  8. New York: North Hudson-Capital Region
  9. Ohio: Statewide and Northern Kentucky Region
  10. Oklahoma: Statewide
  11. Oregon: Statewide
  12. Pennsylvania: Greater Philadelphia Region
  13. Rhode Island: Statewide
  14. Tennessee: Statewide

Building on the Comprehensive Primary Care initiative that launched in late 2012, CPC+ will benefit patients by helping primary care practices:

  • Support patients with serious or chronic diseases achieve their health goals
  • Give patients 24-hour access to care and health information 
  • Deliver preventive care
  • Engage patients and their families in their own care
  • Work together with hospitals and other clinicians, including specialists, to provide better-coordinated care

Practices may participate in one of two CPC+ tracks. In Track 1, CMS will pay practices a monthly fee in addition to regular Medicare fee-for-service payments. In Track 2, practices will receive the monthly fee, as well as a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments to allow greater flexibility in how practices deliver care. Practices in Track 2 will provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of their psychosocial needs and an inventory of resources and supports to meet those needs. To promote high quality and high value care, practices in both tracks will also receive prospective performance-based incentive payments that they will either keep or have to pay back to CMS based on their performance on quality and utilization metrics. In addition, practices that participate in CPC+ may qualify for the additional incentive payments available for the Advanced Alternative Payment Models in the proposed Quality Payment Program beginning 2019.