With less than a year to go in the Obama administration's public-private push for better care management among primary-care providers, the CMS has rolled out a souped-up care-delivery model.
But getting the new five-year demonstration up and running relies on the agency's ability to persuade sufficient numbers of commercial health plans and doctors that it's worth the effort.
The CMS is now recruiting physician practices and state and commercial payers to test the new model in 20 regions of the country, encompassing up to 20,000 doctors and 25 million patients.
Its goal is nothing less than to upend how primary care is delivered and paid for. As CMS officials described the initiative in a piece published last week in JAMA, they want to make physician practices “incentive neutral” relative to the mode of care they deliver and render them no longer “tethered to the 20-minute office visit.”
But state regulatory hurdles and bad experiences with the CMS' earlier pilot program could lead to poor participation in certain parts of the country. Experts say the model also could steer providers away from other alternative payment models.
Under the Comprehensive Primary Care Plus (CPC+) initiative unveiled last week, the CMS and other payers will pay providers a monthly fee for patient care-management services.
A similar but smaller pilot program launched in 2012 that ends this year—the Comprehensive Primary Care initiative, or CPC—reduced total monthly expenditures by 2% per beneficiary in Medicare Parts A and B. Savings attributed to the enhanced care coordination were nearly enough to offset the costs of its fees, but it didn't generate any net savings.
In the new CPC+ program, providers can participate in one of two tracks. In the first track, the CMS will pay a risk-stratified monthly fee for each beneficiary's care- management services, in addition to fee-for-service Medicare payments for primary-care visits.
In the second track, physician practices will receive reduced Medicare fee-for-service payments and more generous upfront care-management payments. The CMS says this “hybrid” payment model will give providers more flexibility to provide care outside of traditional face-to-face encounters. For example, clinical practices might offer telemedicine visits or simply provide longer office visits for patients with complex needs.