The CMS will launch an ambitious primary-care quality improvement initiative in 14 regions, including 11 whole states. The states include Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee.
The markets for the Comprehensive Primary Care Plus, or CPC+, initiative were selected based on density and interest shown by practices and payers. Fifty-seven not-yet-named payers will participate. Other areas in the initiative are the Greater Kansas City, Mo., area; the North Hudson Valley in New York state; the Greater Philadelphia area; and a region that includes all of Ohio and northern Kentucky.
Under CPC+, the CMS and other insurers would pay physicians a monthly fee for patient primary-care visits. The new model aims to improve health outcomes and lower cost not only for Medicare beneficiaries, but also consumers enrolled in commercial plans and other coverage options, such as insurer-managed Medicaid plans.
The CMS said it would only launch the model in markets where there was significant private payer interest. Some plans reacted with concern over how the model was structured.
CPC+ has two tracks. Under track one, providers receive a monthly fee for specific services in addition to the fee-for-service Medicare payments.
But in track two, practices will receive an upfront monthly care-management fee and reduced fee-for-service payments. This hybrid model is designed to let practices provide care outside of the traditional face-to-face encounter, the agency said.
Companies offering preferred provider organization and high-deductible plans told the CMS they could not participate in the program because of legal restrictions in many states. Some states have laws that prohibit non-HMO plans from offering capitated or risk-based payments to physicians.
The CMS saw interest in fewer markets than expected. The model was supposed to launch in up to 20 regions. Still, the CMS estimates that up to 5,000 primary-care practices serving an estimated 3.5 million beneficiaries could participate in the model.
“We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system,” the CMS' chief medical officer, Dr. Patrick Conway, said in a statement.
The agency is soliciting applications from eligible practices within the chosen states and regions through Sept. 15. The model kicks off January 2017.
CMS likely will have little trouble attracting providers since the care-management fees can be a boon for practices.
Depending on the number of patients participating, providers can earn an additional $100,000 to $250,000 per year under the model, according to Lynn Barr, chief transformation officer at Caravan Health, a healthcare consulting firm.
Others agreed. “For practices in the markets, CPC+ is an attractive low-risk option for securing additional funding for efforts to improve care and engage patients,” said Eric Cragun, senior director of health policy at the Advisory Board Co.
Another benefit is that CPC+ counts as an alternative pay model as outlined in the Medicare Access and CHIP Reauthorization Act.
“Participating in CPC+ means they can avoid MIPS, which providers find intimidating,” said Martie Ross, principal at PYA, a national healthcare consulting firm.
