CMS has begun enrolling applications for its new nationwide primary care model, Comprehensive Primary Care Plus (CPC+).
A five-year primary care medical home care model, CPC+ provides incentive payments through the proposed Quality Payment Program. CMS estimates the program could reach as many as 5,000 primary care practices, serving 3.5 million beneficiaries. CPC+ builds on the Comprehensive Primary Care initiative (CPC) that launched in 2012.
Through payment reform and practice transformation, primary care practices can build capabilities and care processes to deliver better care, which will result in a healthier patient population, according to CMS.
The new program is another strategy for working with patients and actively enrolling them, says Ron Sterling, CPA, MBA, of Sterling Solutions, a national independent consultant on electronic health records and medical billing solutions, in Silver Spring, MD.
Healthcare providers need care management to communicate with patients and monitor their care, but they also need technological tools to monitor high-risk patients more consistently, Sterling says.
Care coordination is all about increasing contact with patients and improving their care as efficiently as possible, Sterling says.
“At the end of the day, we only have so many providers,” he says. “And we have an aging population with chronic issues.”
Because of the way demonstration projects like CPC+ are designed to reimburse through incentives, providers have greater flexibility in how they improve patients’ care. They could spend it primarily on care coordination and case management, or use a combination of case management and technological monitoring.
“With a demonstration project, there’s funding,” Sterling says.
Using technology to monitor patients’ vital signs is less costly than having nurses make multiple visits to patients who are having health issues. And technology can make it possible for healthcare providers to monitor patients without actually seeing them each week or month.
For instance, technology exists to monitor continuously a patient’s pain level, wound healing, or to send remotely to doctors the patient’s weight, pulse, blood pressure, and glucose readings. This type of monitoring can be more accurate than having someone call the patient to ask what their weight or readings are, Sterling says.
Technological monitoring helps case managers prioritize which patients they need to call and check on, he adds. “They can focus their attention on the patient who is not doing well or who has not been in touch with the doctor.”
By redesigning the payment model, CMS is giving primary care providers the chance to have greater cash flow and flexibility as they deliver the desired high-quality, whole-person, patient-centered care, CMS officials say.
According to CMS, the new program will benefit patients in the following ways:
- support patients with serious or chronic diseases and help them achieve their health goals,
- give patients 24-hour access to care and health information,
- deliver preventive care,
- engage patients and their families in their own care, and
- work with hospitals and other clinicians, including specialists, to provide better-coordinated care.
The project’s goal is to lower use of unnecessary services that drive the total costs of care, and to build on the agency’s previous efforts in aligning payment reform and providing motivational incentives and robust data sharing.
According to CMS, practices involved with CPC+ will use the following comprehensive primary care functions:
- access and continuity,
- care management,
- comprehensiveness and coordination,
- patient and caregiver engagement, and
- planned care and population health.
Also, the program’s participants will focus on caring for patients with complex medical, behavioral, and psychosocial needs.
Part of the CPC+ work will involve developing strategies to achieve comprehensiveness, such as using analytics to identify population-level needs and to prioritize strategies for meeting those needs, CMS officials say.
Primary care providers will be expected to build capacity within their practices to meet patient needs, and they’ll need to develop strong and coordinated referral networks within their medical neighborhoods.
Comprehensiveness adds breadth and depth to the delivery of primary care services, builds on the element of relationship that is at the heart of effective primary care, and is associated with lower overall utilization and costs, less fragmented care, and better health outcomes, according to CMS.
“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 healthcare system,” said Patrick Conway, MD, MSc, CMS deputy administrator and chief medical officer, in an Aug. 1, 2016, news statement.
“This model allows primary care practices to focus on what they care about most: serving their patients’ needs when and how they choose,” Conway said.
CPC+ will begin in January 2017 for 14 regions, including Arkansas, Colorado, Hawaii, Kansas and Missouri’s Greater Kansas City region, Michigan, Montana, New Jersey, New York, Ohio (including northern Kentucky), Oklahoma, Oregon, Pennsylvania, Rhode Island, and Tennessee.
Primary care practices can choose to participate in the program’s Track 1, in which CMS pays practices a monthly fee in addition to regular Medicare fee-for-service payments, or in Track 2, in which practices receive the monthly fee, as well as a combination of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments that will allow greater flexibility in how practices deliver care.
Using Track 2, primary care practices can provide more comprehensive services for patients with complex medical and behavioral health needs, including addressing their psychosocial issues, according to CMS.
The demonstration project is part of the Affordable Care Act’s Center for Medicare and Medicaid Innovation, which has the ultimate goal of improving healthcare by paying providers for what works, and improving quality.
For more information about the model, visit the CMS website at: http://bit.ly/2c7fqx7, or email CPCplus@cms.hhs.gov.