New CMS Initiative Ties Primary Care Payments to Patient Outcomes

The US Centers for Medicare and Medicaid Services (CMS) recently opened the application period for primary care practices to enroll in a new primary care model.

The new model, called Comprehensive Primary Care Plus (CPC+), is a 5-year initiative to improve primary care beginning in January 2017.

CPC+ will allow practices to provide care for their patients in the way they believe will create the most beneficial results, and will be reimbursed for improving care, according to a press release from the CMS.

An estimated 5000 practices that serve 3.5 million beneficiaries are expected to participate in this initiative. The CMS states practices of varying sizes, structures, and ownership can apply to participate.

CPC+ is a multi-payer model that includes Medicare, state Medicaid, and private insurers partnering to support primary care practices. The CMS identified 14 regions that will benefit from aligning Medicare, Medicaid, and private insurance.

The hope is that this initiative, if successful, will move healthcare from a fee-for-service model to a more personalized and outcomes-based model. The new program builds on a program implemented in 2012.

The new model includes helping patients with chronic illnesses reach their goals, providing patients with 24-hour access to care and information, delivering preventative care, engaging families and patients in their own care, and working with hospitals and specialists to create more coordinated care, according to the press release.

In track 1 of the initiative, practices will receive monthly fees and regular fee-for-service payments. In track 2, practices will receive a monthly fee and a combination of reduced fee-for-service payments and comprehensive primary care payments. Practices that participate in track 2 will provide services for beneficiaries that have more complex medical and behavioral health needs.

Practices in both tracks will also receive performance-based incentive payments that they will keep or give back to the CMS based on performance.

“As a key part of CPC+, CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent, and rural practices,” said Patrick Conway, MD, CMS deputy administrator and chief medical officer. “We see CPC+ as the future of primary care in the US and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system. This model allows primary care practices to focus on what they care about most — serving their patients’ needs when and how they choose.”