The Centers for Medicare and Medicaid Services (CMS) recently announced the open application period for physician practices to participate in a new, nationwide primary care payment model. Comprehensive Primary Care Plus (CPC+) is a primary care medical home that could qualify physicians for the incentive payment for Advanced Alternative Payment Model (APM) participants under the new Medicare Access and CHIP Reauthorization Act (MACRA) starting in 2019.
In designing CPC+, CMS tried to build on physicians’ experience with its predecessor medical home model and give participating practices better opportunities for success. Physicians want to be able to deliver comprehensive, high-quality care for each patient in the most effective way and without a rigid payment system that doesn’t provide the resources they need. Several APMs that are already in use as pilots have proven that APMs can be effective for this purpose.
CPC+ is a five-year primary care medical home model that aims to provide more flexibility and support than is typically available in fee-for-service, especially for non face-to-face services such as proactive patient outreach, care coordination and development of treatment plans. Up to 5,000 practices will be selected to participate.
The AMA has strongly encouraged interested practices to submit applications during the short application period which closes on Thursday, Sept. 15, giving physicians just six weeks to apply. Submit a CPC+ application via the online portal by 11:59 p.m. Eastern time that day. CMS has no plans to allow new applicants later in the five-year period.
CPC+ is a multi-payer model, so other payers will join Medicare in making monthly care management and performance-based payments to participating physician practices. CMS has provisionally selected 57 payer partners, including commercial insurers, state Medicaid agencies, Medicaid managed care organizations and Medicare Advantage plans in 14 regions across the nation. Learn more about the 14 CPC+ regions and provisionally selected payers.
Two tracks for success in CPC+
Practices that are selected for participation will have the option to choose one of two CPC+ tracks for different types of payments. Both tracks promote high quality and high value care and practices will receive prospective performance-based incentive payments.
- Track one: Includes a monthly fee in addition to regular Medicare fee-for-service payments.
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Track two: Practices will receive a monthly fee, but also a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments to grant greater flexibility in how they deliver care. In this track, practices can deliver more comprehensive services for patients with complex medical and behavioral health needs.
CMS has offered several resources for practices that choose to apply. Get your questions answered in the Practice FAQs. Register for one of the 20 upcoming CPC+ Practice Open Door Forums in August and September. Watch the CPC+ Video Series to get an overview of CPC+ payment innovations and care delivery transformation. Download the CPC+ toolkit: CPC+ In Brief, CPC+ Care Delivery Transformation Brief, and CPC+ Payment Innovations Brief and Case Studies
Learn more about APMs
- Tracking patients between visits: A new care model
- New model makes patient care more than face-to-face visits
- Payment model design needs to be physician-led: New report
- How doctors are developing new payment models for their specialties
- Who’s using new delivery and payment models?
- Payment models that can help you better address patients’ needs
- Specialty development key to new payment models’ success
