Lawrence Ward, MD, MPH, an internist in Philadelphia, has been practicing for more than 15 years, witnessing the alphabet soup of quality-improvement programs that have been ladled out by the Centers for Medicare & Medicaid Services (CMS).
The most recent, Comprehensive Primary Care Plus (CPC+), is not like the rest, says Ward, who’s also vice chairman for clinical practice and quality for the Thomas Jefferson University Health System.
“We’ve seen a lot of programs come that don’t lead to real change but involve a lot of extra work,” Ward says. “I think this one’s different. I think this is really what we’ve been waiting for from Medicare for primary care.”
CPC+ is an attempt by CMS to get practices to deliver comprehensive care management while embracing payment reforms. It’s trying to lure practices into the program with generous, upfront financial incentives not tied to fee-for-service revenue—incentives designed to allow them to build their care-management infrastructure.
CPC+ is an updated version of the original Comprehensive Primary Care initiative, which ended in 2016. The initial CPC was a four-year program. CPC+ will run for five years and will be implemented in two rounds.
Almost 2,900 practices in 14 regions are participating in Round 1 of CPC+, which launched in January 2017. To be eligible to participate, practices must have at least 150 fee-for-service beneficiaries recognized by Medicare.
Until July 13, CMS will allow practices in four new regions—Louisiana, Nebraska, North Dakota and Greater Buffalo, New York—to apply for a second round of CPC+, which will launch in January 2018. Only practices in the new regions will be added to the program. Practices in the initial 14 regions and those in non-selected regions cannot participate.
Like its predecessor, CPC+ offers upfront financial incentives to practices that transform their primary care by improving services, including access, continuity, care management and patient/caregiver engagement.
Practices can participate in either Track 1 of the program or a more demanding and ambitious Track 2, which offers bigger payments, but more reporting requirements and benchmarks.
Those financial incentives come in three forms:
1. Care management fees
Every participating practice receives an upfront per-patient, per-month payment that is not tied to practice visits. The amount depends on the patient’s risk score and on the payer. For Medicare beneficiaries, fees average $15 a month per patient for Track 1 and $28 for Track 2. Participating commercial payers—there are 54 in Round 1’s 14 regions—negotiate the incentive amounts with participating practices. This money also is paid prospectively, but must be used for staffing and training related to the program’s objectives.
2. Performance-based incentive payments
These payments also go to practices and reward performance on quality and utilization measures. These are also upfront payments, but practices will have to return at least some of the funds if they do not hit performance goals.