CMS selects four new markets for primary-care payment initiative

The CMS is doing a much more limited expansion of its primary-care payment model than originally anticipated due to low interest in the model.

The second round of the Comprehensive Primary Care Plus initiative will only expand to four new markets starting in January 2018. Earlier this year, the agency anticipated expanding in up to 10 new markets. The new areas include Louisiana, Nebraska, North Dakota and the Greater Buffalo Region in New York, which encompasses Erie and Niagara.

The first round of the model kicked off in 14 regions spanning 2,893 medical practices and 1.76 million Medicare beneficiaries in January 2017.

Under CPC+, the CMS and other insurers pay physicians a monthly fee for patient primary-care visits. The 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 managed care Medicaid plans.

Because of the need for insurance company partners, the model could only be expanded to areas where there was strong payer interest, the agency noted. The CMS will be partnering with Blue Cross Blue Shield of Western New York and Independent Health Association for the two counties in New York. Blue Cross Blue Shield of Louisiana, Amerigroup and AmeriHealth Caritas in Louisiana and Blue Cross Blue Shield of Nebraska and Blue Cross Blue Shield of North Dakota for those states.

It's unclear why there was limited interest in Round 2 and the CMS didn't address the matter in its announcement. A 2012 pilot version of the program upset some private payers who felt it didn't generate savings and that the CMS wasn't a good partner.

The CMS is now soliciting proposal from providers in the four new regions to work under the model through July 13. It hopes as many as 1,000 primary care practices will join the program.

The agency may miss that goal as well as Round 2 of CPC+ will randomly split providers into two groups, with one receiving such CPC+ payments as care-management fees, performance-based incentive payments or comprehensive primary-care payments, while the other will not.

Experts have said that may dissuade providers from applying. Clinicians are also increasingly struggling with new payment model fatigue as several have launched in recent years according to David Introcaso, AMGA's senior director of regulatory and public policy.