New CMS model incentivizes providers toward value-based care

CMS has introduced a new model that takes another step in moving away from the traditional fee-for-service model in primary care.

The Comprehensive Primary Care Plus (CPC+) program for Medicare beneficiaries announced by CMS, is a regionally-based, multipayer care delivery and alternative payment model (APM) that rewards value and quality through an innovative payment structure to support comprehensive primary care. The model will offer two tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices.

Hall

CPC+ will be a five-year evaluation-beginning in January 2017-of what is essentially the Medicaid primary care case management (PCCM) program versus a partial capitation program plus payments for care management services, according to Managed Healthcare Executive Editorial Advisor Don Hall, a former health plan CEO, principal, Delta Sigma LLC, in Littleton, Colo.

“Both approaches will employ various pay-for-performance incentives,” Hall says. “CMS will be contracting with health plans to recruit primary care practices and to administer the program.”

CPC+ builds on a previous pilot program developed under the Affordable Care Act, the Comprehensive Primary Care Initiative (CPC), according to Hall.

CMS says the initiative can accommodate up to 5,000 practices, which would encompass more than 20,000 providers and 25 million patients across the country.

CPC+ will include two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States. According to Medical Economics, in Track 1, practices will receive a monthly care management fee from CMS in addition to fee-for-service payments under the Medicare physician fee schedule. In Track 2, practices will also receive a monthly care management fee, but instead of full fee-for-service payments they will receive what CMS describes as “a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services.” The goal is to allow practices more flexibility in delivering care outside of the traditional face-to-face encounter.

Beginning on April 15, 2016, CMS will solicit payer proposals to partner in CPC+.