CMS’ Center for Medicare and Medicaid Innovation (CMMI) recently announced their new Comprehensive Primary Care Plus (CPC+) program. This program is aimed at rewarding quality and value among the primary care providers.
The CPC+ care program contains two tracked reward systems, out of which, the first track includes a Per Patient Fee in addition to the normal Fee For Service (FFS) payments. This is made to facilitate an improvement in the care management systems. The second track also has a monthly Per Patient Fee, but has a system of decreased FFS payments and extra upfront payments, which is aimed at aggressively modifying the care practices.
Unlike the other payment reform initiatives, CPC+ is a multi-payer reform initiative, designed to bring together commercial insurance plans, CMS, and State Medicaid agencies, to offer financial support to practices. The financial support is aimed to help practices make changes in their care delivery system.
Payers who agree to participate in the CPC+ program need to sign a Memorandum of Understanding (MOU). This is to be signed to agree to align with the other participating health plans on payment, quality metrics, and data sharing throughout the five years.
Originally, CMS intended to choose up to 20 regions of the country to participate in CPC+ program, but they have changed minds now, and announced that only 14 states are selected to take part in the program. Health service providers in the chosen areas can apply to take part in the program from August 1 to September 15.
Medical practices are also expected to meet some quality and value standards under the CPC+ program. If the provider fails to achieve these standards, they will need to pay back a part of the extra payment they received.
The CPC+ program is an improvement on the CPC program that was introduced in 2012. The renovated model primarily aims to reform functions like planned and preventive care, access and continuity, risk-stratified care management, care coordination, and patient and caregiver engagement.