Why do Patients Need and Physicians Deserve CPC+?

Abhinav Shashank
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Amid the transition to value-based care, reimbursement for health care and tying it to quality and performance remains one of the major challenges in eradicating fee-for service models. According to a survey, only 41% of the physicians still placed their confidence in fee-for-service model for delivering patient outcomes.

 

In August 2016, CMS with the aim to enhance the quality of care rolled out the Comprehensive Primary Care Plus (CPC+) initiative, a five-year model that will begin in January 2017. The model is built on the foundations of Comprehensive Primary Care (CPC) and is much more than the five functions of CPC, with the aim to change how care is delivered across the population.

 

What is CPC+?

CPC+, or Comprehensive Primary Care Plus builds on the Comprehensive Primary Care initiative, launched by CMS in 2012. Bringing together Medicare, commercial insurers, and state-run insurance companies together, CPC+ centers its focus on five key goals:

  • Ensuring access and continuity of care.
  • Comprehensive care delivery and management.
  • Improving care coordination.
  • Enhancing patient and caregiver engagement.
  • Delivering planned care and improve population health.

 

Key Components in CPC+

Under this initiative, CMS will be partnering with private payors and state Medicaid agencies with the goal to provide monthly care management on a fee based on beneficiary risk tiers. The participating PCPs can be a part of one of the two tracks:

 

  • Track 1: In Track 1, PCPs will receive an average monthly care management fee from CMS; $15 per beneficiary along with their fee-for-service payments. They will also be eligible for a performance-based incentive of $2.50 per beneficiary, per month.
  • Track 2: PCPs participating in Track 2 will be providing more comprehensive services than PCPs in Track 1, and will be receiving an average monthly care management fee of $28 per beneficiary. The practices will also be eligible for a performance-based incentive of $4 per beneficiary per month.

 

Looping in Health IT

CPC+ has a substantial focus on health IT and technological support to boost the quality of primary care. The most important task CPC+ will accomplish is driving improvements in the quality of care through data. CMS has laid down a few regulations to ensure participating practices comply with the technological requirements:

  • All practices participating in CPC+ must have a certified electronic health record technology (CEHRT).
  • The deployed CEHRT should be capable of utilizing a patient-centered planning tool, tracking patients’ health status, linking results in care plans, and designing interventions in real time.
  • PCPs have to submit a letter of support from their appointed health IT vendor articulating their commitment to supporting practices with their health IT capabilities.

 

How will CPC+ redesign care delivery?

There are several ways in which CPC+ will affect healthcare organizations in redesigning care processes. The primary focus of the initiative being preventive care, providers will have a good chance of introducing new changes in their services:

  • CPC+ will encourage PCPs to introduce more services that are not currently billable or don’t have a substantial contribution in improving margin- like conversations with care teams, behavioral health, etc.
  • The initiative aims to change how providers design workflows and utilize resources among the caregivers. Since a care management fee is provided to the practices, practices can exercise better control in delivering services.

 

What do you need to be CPC+ ready?

CPC+ has been recognized as an advanced alternative payment model and there are a lot of looming questions: Is the model suited to your practice? Will joining CPC+ affect your year-long strategy? Which track to participate in? How will practices be affected under MACRA?

 

Here’s what practices should tick off before participating in CPC+:

  • Check if your practice meets the mentioned eligibility requirements of region, type of providers, and eligible clinicians.
  • Calculate and analyze the most-likely financial impact.
  • Monitor the investments made and find what track would be the most suitable for your practice.
  • Pay attention to educating and engaging providers.
  • Analyze and discuss how participating in CPC+ will affect the organization.
  • Engage an IT vendor with advanced analytics capabilities.

 

The Road Ahead

Comprehensive Primary Care Plus is a bold policy step that acknowledges the importance of task support and care delivery in a clinical network. CPC+ will encourage clinical systems and PCPs to use the information at hand and redesign how care is provided and billed. This new model holds a promise of a shared commitment to align on payment, data sharing, and quality care. CPC+ gives way to a new, stronger bond between patients and providers, cemented by technology and to delivering better, quality health outcomes.

 

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